   A100100VDRESSING FOR ONE WOUND                                                          Dressing for one wound                                                                                                                    C                                      2002070120020701        N                           
   A200100VDRESSING FOR TWO WOUNDS                                                         Dressing for two wounds                                                                                                                   C                                      2002070120020701        N                           
   A300100VDRESSING FOR THREE WOUNDS                                                       Dressing for three wounds                                                                                                                 C                                      2002070120020701        N                           
   A400100VDRESSING FOR FOUR WOUNDS                                                        Dressing for four wounds                                                                                                                  C                                      2002070120020701        N                           
   A500100VDRESSING FOR FIVE WOUNDS                                                        Dressing for five wounds                                                                                                                  C                                      2002070120020701        N                           
   A600100VDRESSING FOR SIX WOUNDS                                                         Dressing for six wounds                                                                                                                   C                                      2002070120020701        N                           
   A700100VDRESSING FOR SEVEN WOUNDS                                                       Dressing for seven wounds                                                                                                                 C                                      2002070120020701        N                           
   A800100VDRESSING FOR EIGHT WOUNDS                                                       Dressing for eight wounds                                                                                                                 C                                      2002070120020701        N                           
   A900100VDRESSING FOR NINE OR MORE WOUNDS                                                Dressing for 9 or more wound                                                                                                              C                                      2002070120020701        N                           
   AA00100VANESTHESIA SERVICES PERFORMED PERSONALLY BY ANESTHESIOLOGIST                    Anesthesia perf by anesgst                             3350.5                                                                             D                                      1984010120010101        N                           
   AD00100VMEDICAL SUPERVISION BY A PHYSICIAN: MORE THAN FOUR CONCURRENT ANESTHESIA        MD supervision, >4 anes proc                           3350.5                                                                             D                                      1984010120010101        N                           
   AD00200WPROCEDURES                                                                                                                                                                                                                                                                                                           
   AE00100VREGISTERED DIETICIAN                                                            Registered dietician                                                                                                                      C                                      2005010120050101        N                           
   AF00100VSPECIALTY PHYSICIAN                                                             Specialty physician                                                                                                                       C                                      2005010120050101        N                           
   AG00100VPRIMARY PHYSICIAN                                                               Primary physician                                                                                                                         C                                      2005010120050101        N                           
   AH00100VCLINICAL PSYCHOLOGIST                                                           Clinical psychologist                                  2150    5112                                                                       D                                      1991010119970101        N                           
   AJ00100VCLINICAL SOCIAL WORKER                                                          Clinical social worker                                 2152    5113                                                                       D                                      1991010119970101        N                           
   AK00100VNON PARTICIPATING PHYSICIAN                                                     Non participating physician                                                                                                               C                                      2005010120050101        N                           
   AM00100VPHYSICIAN, TEAM MEMBER SERVICE                                                  Physician, team member svc                             4105.7                                                       QM                    D                      0069            1991010119970101        N                           
   AP00100VDETERMINATION OF REFRACTIVE STATE WAS NOT PERFORMED IN THE COURSE OF DIAGNOSTIC No dtmn of refractive state                                                                                                               C                                      1984010119970101        N                           
   AP00200WOPHTHALMOLOGICAL EXAMINATION                                                                                                                                                                                                                                                                                         
   AQ00100VPHYSICIAN PROVIDING A SERVICE IN AN UNLISTED HEALTH PROFESSIONAL SHORTAGE AREA  Physician service HPSA area                                                                                                               C                                      2006010120060101        A                           
   AQ00200W(HPSA)                                                                                                                                                                                                                                                                                                               
   AR00100VPHYSICIAN PROVIDER SERVICES IN A PHYSICIAN SCARCITY AREA                        Physician scarcity area                                                                                                                   C                                      2005010120050101        N                           
   AS00100VPHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR CLINICAL NURSE SPECIALIST SERVICES  Assistant at surgery service                                                                                                              C                      0069            1988010119990101        N                           
   AS00200WFOR ASSISTANT AT SURGERY                                                                                                                                                                                                                                                                                             
   AT00100VACUTE TREATMENT (THIS MODIFIER SHOULD BE USED WHEN REPORTING SERVICE 98940,     Acute treatment                                                                                                                           C                                      1984010119980101        N                           
   AT00200W98941, 98942)                                                                                                                                                                                                                                                                                                        
   AU00100VITEM FURNISHED IN CONJUNCTION WITH A UROLOGICAL, OSTOMY, OR TRACHEOSTOMY SUPPLY Uro, ostomy or trach item                                                                                                                 C                                      2003010120030101        N                           
   AV00100VITEM FURNISHED IN CONJUNCTION WITH A PROSTHETIC DEVICE, PROSTHETIC OR ORTHOTIC  Item w prosthetic/orthotic                                                                                                                C                                      2003010120030101        N                           
   AW00100VITEM FURNISHED IN CONJUNCTION WITH A SURGICAL DRESSING                          Item w a surgical dressing                                                                                                                C                                      2003010120030101        N                           
   AX00100VITEM FURNISHED IN CONJUNCTION WITH DIALYSIS SERVICES                            Item w dialysis services                                                                                                                  C                      0000            2003010120030101        N                           
   BA00100VITEM FURNISHED IN CONJUNCTION WITH PARENTERAL ENTERAL NUTRITION (PEN) SERVICES  Item w pen services                                                                                                                       C                                      2003010120030101        N                           
   BL00100VSPECIAL ACQUISITION OF BLOOD AND BLOOD PRODUCTS                                 Spec acquisition blood prods                                                                                                              C                                      2005070120050701        A                           
   BO00100VORALLY ADMINISTERED NUTRITION, NOT BY FEEDING TUBE                              Nutrition oral admin no tube                                                                                                              C                                      2003010120030101        N                           
   BP00100VTHE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND HAS    Bene electd to purchase item                                                                                                              C                                      1992010119970101        N                           
   BP00200WELECTED TO PURCHASE THE ITEM                                                                                                                                                                                                                                                                                         
   BR00100VTHE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND HAS    Bene elected to rent item                                                                                                                 C                                      1992010119970101        N                           
   BR00200WELECTED TO RENT THE ITEM                                                                                                                                                                                                                                                                                             
   BU00100VTHE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND AFTER  Bene undecided on purch/rent                                                                                                              C                                      1992010119970101        N                           
   BU00200W30 DAYS HAS NOT INFORMED THE SUPPLIER OF HIS/HER DECISION                                                                                                                                                                                                                                                            
   CA00100VPROCEDURE PAYABLE ONLY IN THE INPATIENT SETTING WHEN PERFORMED EMERGENTLY ON AN Procedure payable inpatient                                                                                                               C                                      2003010120030101        N                           
   CA00200WOUTPATIENT WHO EXPIRES PRIOR TO ADMISSION                                                                                                                                                                                                                                                                            
   CB00100VSERVICE ORDERED BY A RENAL DIALYSIS FACILITY (RDF) PHYSICIAN AS PART OF THE     ESRD bene part a snf-sep pay                                                                                                              C                                      2003040120040101        N                           
   CB00200WESRD BENEFICIARY'S DIALYSIS BENEFIT, IS NOT PART OF THE COMPOSITE RATE, AND IS                                                                                                                                                                                                                                       
   CB00300WSEPARATELY REIMBURSABLE                                                                                                                                                                                                                                                                                              
   CC00100VPROCEDURE CODE CHANGE (USE 'CC' WHEN THE PROCEDURE CODE SUBMITTED WAS CHANGED   Procedure code change                                                                                                                     C                                      1990010119970101        N                           
   CC00200WEITHER FOR ADMINISTRATIVE REASONS OR BECAUSE AN INCORRECT CODE WAS FILED)                                                                                                                                                                                                                                            
   CD00100VAMCC 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                           
   CD00200WTHE COMPOSITE RATE AND IS NOT SEPARATELY BILLABLE                                                                                                                                                                                                                                                                    
   CE00100VAMCC 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                           
   CE00200WCOMPOSITE RATE TEST BUT IS BEYOND THE NORMAL FREQUENCY COVERED UNDER THE RATE                                                                                                                                                                                                                                        
   CE00300WAND IS SEPARATELY REIMBURSABLE BASED ON MEDICAL NECESSITY                                                                                                                                                                                                                                                            
   CF00100VAMCC TEST HAS BEEN ORDERED BY AN ESRD FACILITY OR MCP PHYSICIAN THAT IS NOT     AMCC tst not composite rate                            4270.2                                                                             D                                      2004010120040101        N                           
   CF00200WPART OF THE COMPOSITE RATE AND IS SEPARATELY BILLABLE                                                                                                                                                                                                                                                                
   CR00100VCATASTROPHE/DISASTER RELATED                                                    Catastrophe/disaster related                                                                                                              C                                      2005082120050821        A                           
   E100100VUPPER LEFT, EYELID                                                              Upper left eyelid                                                                                                                         C                                      1995010119990101        N                           
   E200100VLOWER LEFT, EYELID                                                              Lower left eyelid                                                                                                                         C                                      1995010119990101        N                           
   E300100VUPPER RIGHT, EYELID                                                             Upper right eyelid                                                                                                                        C                                      1995010119990101        N                           
   E400100VLOWER RIGHT, EYELID                                                             Lower right eyelid                                                                                                                        C                                      1995010119990101        N                           
   EJ00100VSUBSEQUENT CLAIMS FOR A DEFINED COURSE OF THERAPY, E.G., EPO, SODIUM            Subsequent claim                                       4273.2                                                                             D                                      1991010120000101        N                           
   EJ00200WHYALURONATE, INFLIXIMAB                                                                                                                                                                                                                                                                                              
   EM00100VEMERGENCY RESERVE SUPPLY (FOR ESRD BENEFIT ONLY)                                Emer reserve supply (ESRD)                             3045.7                                                                             D                                      1991010119970101        N                           
   EP00100VSERVICE PROVIDED AS PART OF MEDICAID EARLY PERIODIC SCREENING DIAGNOSIS AND     Medicaid EPSDT program svc                                                                                                                C                                      1987010119970101        N                           
   EP00200WTREATMENT (EPSDT) PROGRAM                                                                                                                                                                                                                                                                                            
   ET00100VEMERGENCY SERVICES                                                              Emergency Services                                                                                                                        C                                      1984010120020101        N                           
   EY00100VNO PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER ORDER FOR THIS ITEM OR      No md order for item/service                                                                                                              C                                      2003010120030101        N                           
   EY00200WSERVICE                                                                                                                                                                                                                                                                                                              
   F100100VLEFT HAND, SECOND DIGIT                                                         Left hand, second digit                                                                                                                   C                                      1995010119990101        N                           
   F200100VLEFT HAND, THIRD DIGIT                                                          Left hand, third digit                                                                                                                    C                                      1995010119990101        N                           
   F300100VLEFT HAND, FOURTH DIGIT                                                         Left hand, fourth digit                                                                                                                   C                                      1995010119990101        N                           
   F400100VLEFT HAND, FIFTH DIGIT                                                          Left hand, fifth digit                                                                                                                    C                                      1995010119990101        N                           
   F500100VRIGHT HAND, THUMB                                                               Right hand, thumb                                                                                                                         C                                      1995010119990101        N                           
   F600100VRIGHT HAND, SECOND DIGIT                                                        Right hand, second digit                                                                                                                  C                                      1995010119990101        N                           
   F700100VRIGHT HAND, THIRD DIGIT                                                         Right hand, third digit                                                                                                                   C                                      1995010119990101        N                           
   F800100VRIGHT HAND, FOURTH DIGIT                                                        Right hand, fourth digit                                                                                                                  C                                      1995010119990101        N                           
   F900100VRIGHT HAND, FIFTH DIGIT                                                         Right hand, fifth digit                                                                                                                   C                                      1995010119990101        N                           
   FA00100VLEFT HAND, THUMB                                                                Left hand, thumb                                                                                                                          C                                      1995010119990101        N                           
   FB00100VITEM PROVIDED WITHOUT COST TO PROVIDER, SUPPLIER OR PRACTITIONER (EXAMPLES, BUT Item provided without cost                                                                                                                I                                      2006010120060101        A                           
   FB00200WNOT LIMITED TO: COVERED UNDER WARRANTY, REPLACED DUE TO DEFECT, FREE SAMPLES)                                                                                                                                                                                                                                        
   FP00100VSERVICE PROVIDED AS PART OF FAMILY PLANNING PROGRAM                             Svc part of family plan pgm                                                                                                               C                                      1987010120050101        N                           
   G100100VMOST RECENT URR READING OF LESS THAN 60                                         URR reading of less than 60                                                                                                               C                                      1997010119980101        N                           
   G200100VMOST RECENT URR READING OF 60 TO 64.9                                            URR reading of 60 to 64.9                                                                                                                C                                      1997010119980101        N                           
   G300100VMOST RECENT URR READING OF 65 TO 69.9                                           URR  reading of 65 to 69.9                                                                                                                C                                      1997010119980101        N                           
   G400100VMOST RECENT URR READING OF 70 TO 74.9                                           URR reading of 70 to 74.9                                                                                                                 C                                      1997010119970101        N                           
   G500100VMOST RECENT URR READING OF 75 OR GREATER                                        URR reading of 75 or greater                                                                                                              C                                      1997010119980101        N                           
   G600100VESRD PATIENT FOR WHOM LESS THAN SIX DIALYSIS SESSIONS HAVE BEEN PROVIDED IN A   ESRD patient <6 dialysis/mth                                                                                                              C                                      1998050119980501        N                           
   G600200WMONTH                                                                                                                                                                                                                                                                                                                
   G700100VPREGNANCY RESULTED FROM RAPE OR INCEST OR PREGNANCY CERTIFIED BY PHYSICIAN AS   Payment limits do not apply          35-99             2005.1                                                                             D                      0084            1999070119990701        N                           
   G700200WLIFE THREATENING                                                                                                                                                                                                                                                                                                     
   G800100VMONITORED ANESTHESIA CARE (MAC) FOR DEEP COMPLEX, COMPLICATED, OR MARKEDLY      Monitored anesthesia care                                                                                                                 C                      0083            1999070119990701        N                           
   G800200WINVASIVE SURGICAL PROCEDURE                                                                                                                                                                                                                                                                                          
   G900100VMONITORED ANESTHESIA CARE FOR PATIENT WHO HAS HISTORY OF SEVERE                 MAC for at risk patient                                                                                                                   C                                      1999070119990701        N                           
   G900200WCARDIO-PULMONARY CONDITION                                                                                                                                                                                                                                                                                           
   GA00100VWAIVER OF LIABILITY STATEMENT ON FILE                                           Waiver of Liability on file                                                                                                               C                                      1995010119970101        N                           
   GB00100VCLAIM BEING RE-SUBMITTED FOR PAYMENT BECAUSE IT IS NO LONGER COVERED UNDER A    Claim resubmitted                                                                                                                         C                                      2002010120020101        N                           
   GB00200WGLOBAL PAYMENT DEMONSTRATION                                                                                                                                                                                                                                                                                         
   GC00100VTHIS SERVICE HAS BEEN PERFORMED IN PART BY A RESIDENT UNDER THE DIRECTION OF A  Resident/teaching phys serv                            3350.5  4116                                                                       D                                      1997010120010101        N                           
   GC00200WTEACHING PHYSICIAN                                                                                                                                                                                                                                                                                                   
   GE00100VTHIS SERVICE HAS BEEN PERFORMED BY A RESIDENT WITHOUT THE PRESENCE OF A         Resident prim care exception                           4116                                                                               D                                      1997010119970101        N                           
   GE00200WTEACHING PHYSICIAN UNDER THE PRIMARY CARE EXCEPTION                                                                                                                                                                                                                                                                  
   GF00100VNON-PHYSICIAN (E.G. NURSE PRACTITIONER (NP), CERTIFIED REGISTERED NURSE         Nonphysician serv c a hosp                                                                                                                C                                      2003040120030401        N                           
   GF00200WANESTHETIST (CRNA), CERTIFIED REGISTERED NURSE (CRN), CLINICAL NURSE SPECIALIST                                                                                                                                                                                                                                      
   GF00300W(CNS), PHYSICIAN ASSISTANT (PA)) SERVICES IN A CRITICAL ACCESS HOSPITAL                                                                                                                                                                                                                                              
   GG00100VPERFORMANCE AND PAYMENT OF A SCREENING MAMMOGRAM AND DIAGNOSTIC MAMMOGRAM ON    Payment screen mam + diagmam                                                                                                              C                                      2002010120020101        N                           
   GG00200WTHE SAME PATIENT, SAME DAY                                                                                                                                                                                                                                                                                           
   GH00100VDIAGNOSTIC MAMMOGRAM CONVERTED FROM SCREENING MAMMOGRAM ON SAME DAY             Diag mammo to screening mamo                                                                                                              C                                      1998100119981001        N                           
   GJ00100V"OPT OUT" PHYSICIAN OR PRACTITIONER EMERGENCY OR URGENT SERVICE                 Opt out provider of er srvc                                                                                                               C                                      1998100119981001        N                           
   GK00100VACTUAL ITEM/SERVICE ORDERED BY PHYSICIAN, ITEM ASSOCIATED WITH GA OR GZ MODIFIERActual item/service ordered                                                                                                               C                                      2002010120020101        N                           
   GL00100VMEDICALLY UNNECESSARY UPGRADE PROVIDED INSTEAD OF STANDARD ITEM, NO CHARGE, NO  Upgraded item, no charge                                                                                                                  C                                      2002010120020101        N                           
   GL00200WADVANCE BENEFICIARY NOTICE (ABN)                                                                                                                                                                                                                                                                                     
   GM00100VMULTIPLE PATIENTS ON ONE AMBULANCE TRIP                                         Multiple transports                                                                                                                       C                                      2002010120020101        N                           
   GN00100VSERVICES DELIVERED UNDER AN OUTPATIENT SPEECH LANGUAGE PATHOLOGY PLAN OF CARE   OP speech language service                                                                                                                C                                      1999010120030101        N                           
   GO00100VSERVICES DELIVERED UNDER AN OUTPATIENT OCCUPATIONAL THERAPY PLAN OF CARE        OP occupational therapy serv                                                                                                              C                                      1999010120030101        N                           
   GP00100VSERVICES DELIVERED UNDER AN OUTPATIENT PHYSICAL THERAPY PLAN OF CARE            OP PT services                                                                                                                            C                                      1999010120030101        N                           
   GQ00100VVIA ASYNCHRONOUS TELECOMMUNICATIONS SYSTEM                                      Telehealth store and forward                                                                                                              C                                      2001100120011001        N                           
   GR00100VTHIS SERVICE WAS PERFORMED IN WHOLE OR IN PART BY A RESIDENT IN A DEPARTMENT OF Service by va resident                                                                                                                    C                                      2006010120060101        A                           
   GR00200WVETERANS AFFAIRS MEDICAL CENTER OR CLINIC, SUPERVISED IN ACCORDANCE WITH VA                                                                                                                                                                                                                                          
   GR00300WPOLICY                                                                                                                                                                                                                                                                                                               
   GS00100VDOSAGE OF EPO OR DARBEPOIETIN ALFA HAS BEEN REDUCED 25% OF PRECEEDING MONTH'S   Epo/darbepoietin reduced 25%                           4273.1                                                                             D                                      2006010120060101        A                           
   GS00200WDOSAGE                                                                                                                                                                                                                                                                                                               
   GT00100VVIA INTERACTIVE AUDIO AND VIDEO TELECOMMUNICATION SYSTEMS                       InteractiveTelecommunication                                                                                                              D                      0073            1999010119990101        N                           
   GV00100VATTENDING PHYSICIAN NOT EMPLOYED OR PAID UNDER ARRANGEMENT BY THE PATIENT'S     Attending phys not hospice                             4175-5                                                                             D                                      2002010120020101        N                           
   GV00200WHOSPICE PROVIDER                                                                                                                                                                                                                                                                                                     
   GW00100VSERVICE NOT RELATED TO THE HOSPICE PATIENT'S TERMINAL CONDITION                 Service unrelated to term co                           4175-5                                                                             D                                      2002010120020101        N                           
   GY00100VITEM OR SERVICE STATUTORILY EXCLUDED OR DOES NOT MEET THE DEFINITION OF ANY     Statutorily excluded                                                                                                                      S                                      2002010120020101        N                           
   GY00200WMEDICARE BENEFIT                                                                                                                                                                                                                                                                                                     
   GZ00100VITEM OR SERVICE EXPECTED TO BE DENIED AS NOT REASONABLE AND NECESSARY           Not reasonable and necessary                           2000                                                                               M                                      2002010120020101        N                           
   H900100VCOURT-ORDERED                                                                   Court-ordered                                                                                                                             I                                      2003010120030101        N                           
   HA00100VCHILD/ADOLESCENT PROGRAM                                                        Child/adolescent program                                                                                                                  I                                      2003010120030101        N                           
   HB00100VADULT PROGRAM, NON GERIATRIC                                                    Adult program non-geriatric                                                                                                               I                                      2003010120030101        N                           
   HC00100VADULT PROGRAM, GERIATRIC                                                        Adult program geriatric                                                                                                                   I                                      2003010120030101        N                           
   HD00100VPREGNANT/PARENTING WOMEN'S PROGRAM                                              Pregnant/parenting program                                                                                                                I                                      2003010120030101        N                           
   HE00100VMENTAL HEALTH PROGRAM                                                           Mental health program                                                                                                                     I                                      2003010120030101        N                           
   HF00100VSUBSTANCE ABUSE PROGRAM                                                         Substance abuse program                                                                                                                   I                                      2003010120030101        N                           
   HG00100VOPIOID ADDICTION TREATMENT PROGRAM                                              Opioid addiction tx program                                                                                                               I                                      2003010120030101        N                           
   HH00100VINTEGRATED MENTAL HEALTH/SUBSTANCE ABUSE PROGRAM                                Mental hlth/substance abs pr                                                                                                              I                                      2003010120030101        N                           
   HI00100VINTEGRATED MENTAL HEALTH AND MENTAL RETARDATION/DEVELOPMENTAL DISABILITIES      M hlth/m retrdtn/dev dis pro                                                                                                              I                                      2003010120030101        N                           
   HI00200WPROGRAM                                                                                                                                                                                                                                                                                                              
   HJ00100VEMPLOYEE ASSISTANCE PROGRAM                                                     Employee assistance program                                                                                                               I                                      2003010120030101        N                           
   HK00100VSPECIALIZED MENTAL HEALTH PROGRAMS FOR HIGH-RISK POPULATIONS                    Spec hgh rsk mntl hlth pop p                                                                                                              I                                      2003010120030101        N                           
   HL00100VINTERN                                                                          intern                                                                                                                                    I                                      2003010120030101        N                           
   HM00100VLESS THAN BACHELOR DEGREE LEVEL                                                 Less than bachelor degree lv                                                                                                              I                                      2003010120030101        N                           
   HN00100VBACHELORS DEGREE LEVEL                                                          Bachelors degree level                                                                                                                    I                                      2003010120030101        N                           
   HO00100VMASTERS DEGREE LEVEL                                                            Masters degree level                                                                                                                      I                                      2003010120030101        N                           
   HP00100VDOCTORAL LEVEL                                                                  Doctoral level                                                                                                                            I                                      2003010120030101        N                           
   HQ00100VGROUP SETTING                                                                   Group setting                                                                                                                             I                                      2003010120030101        N                           
   HR00100VFAMILY/COUPLE WITH CLIENT PRESENT                                               Family/couple w client prsnt                                                                                                              I                                      2003010120030101        N                           
   HS00100VFAMILY/COUPLE WITHOUT CLIENT PRESENT                                            Family/couple w/o client prs                                                                                                              I                                      2003010120030101        N                           
   HT00100VMULTI-DISCIPLINARY TEAM                                                         Multi-disciplinary team                                                                                                                   I                                      2003010120030101        N                           
   HU00100VFUNDED BY CHILD WELFARE AGENCY                                                  Child welfare agency funded                                                                                                               I                                      2003010120030101        N                           
   HV00100VFUNDED STATE ADDICTIONS AGENCY                                                  Funded state addiction agncy                                                                                                              I                                      2003010120030101        N                           
   HW00100VFUNDED BY STATE MENTAL HEALTH AGENCY                                            State mntl hlth agncy funded                                                                                                              I                                      2003010120030101        N                           
   HX00100VFUNDED BY COUNTY/LOCAL AGENCY                                                   County/local agency funded                                                                                                                I                                      2003010120030101        N                           
   HY00100VFUNDED BY JUVENILE JUSTICE AGENCY                                               Funded by juvenile justice                                                                                                                I                                      2003010120030101        N                           
   HZ00100VFUNDED BY CRIMINAL JUSTICE AGENCY                                               Criminal justice agncy fund                                                                                                               I                                      2003010120030101        N                           
   J100100VCOMPETITIVE ACQUISITION PROGRAM NO-PAY SUBMISSION FOR A PRESCRIPTION NUMBER     CAP no-pay for prescript num                                                                                                              C                                      2006010120060101        A                           
   J200100VCOMPETITIVE ACQUISITION PROGRAM, RESTOCKING OF EMERGENCY DRUGS AFTER EMERGENCY  CAP restock of emerg drugs                                                                                                                C                                      2006010120060101        A                           
   J200200WADMINISTRATION                                                                                                                                                                                                                                                                                                       
   J300100VCOMPETITIVE ACQUISITION PROGRAM (CAP), DRUG NOT AVAILABLE THROUGH CAP AS        CAP drug unavail thru cap                                                                                                                 C                                      2006010120060101        A                           
   J300200WWRITTEN, REIMBURSED UNDER AVERAGE SALES PRICE METHODOLOGY                                                                                                                                                                                                                                                            
   JW00100VDRUG AMOUNT DISCARDED/NOT ADMINISTERED TO ANY PATIENT                           Discarded drug not administe                                                                                                              C                                      2003010120030101        N                           
   K000100VLOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 0 - DOES NOT HAVE THE ABILITY OR    Lwr ext prost functnl lvl 0                                                                                                               C                                      1993010120030101        N                           
   K000200WPOTENTIAL TO AMBULATE OR TRANSFER SAFELY WITH OR WITHOUT ASSISTANCE AND A                                                                                                                                                                                                                                            
   K000300WPROSTHESIS DOES NOT ENHANCE THEIR QUALITY OF LIFE OR MOBILITY.                                                                                                                                                                                                                                                       
   K100100VLOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 1 - HAS THE ABILITY OR POTENTIAL TO Lwr ext prost functnl lvl 1                                                                                                               C                                      1993010119970101        N                           
   K100200WUSE A PROSTHESIS FOR TRANSFERS OR AMBULATION ON LEVEL SURFACES AT FIXED                                                                                                                                                                                                                                              
   K100300WCADENCE. TYPICAL OF THE LIMITED AND UNLIMITED HOUSEHOLD AMBULATOR.                                                                                                                                                                                                                                                   
   K200100VLOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 2 - HAS THE ABILITY OR POTENTIAL    Lwr ext prost functnl lvl 2                                                                                                               C                                      1993010119970101        N                           
   K200200WFOR AMBULATION WITH THE ABILITY TO TRAVERSE LOW LEVEL ENVIRONMENTAL BARRIERS                                                                                                                                                                                                                                         
   K200300WSUCH AS CURBS, STAIRS OR UNEVEN SURFACES.  TYPICAL OF THE LIMITED COMMUNITY                                                                                                                                                                                                                                          
   K200400WAMBULATOR.                                                                                                                                                                                                                                                                                                           
   K300100VLOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 3 - HAS THE ABILITY OR POTENTIAL    Lwr ext prost functnl lvl 3                                                                                                               C                                      1993010119970101        N                           
   K300200WFOR AMBULATION WITH VARIABLE CADENCE.  TYPICAL OF THE COMMUNITY AMBULATOR WHO                                                                                                                                                                                                                                        
   K300300WHAS THE ABILITY TO TRANSVERSE MOST ENVIRONMENTAL BARRIERS AND MAY HAVE                                                                                                                                                                                                                                               
   K300400WVOCATIONAL, THERAPEUTIC, OR EXERCISE ACTIVITY THAT DEMANDS PROSTHETIC                                                                                                                                                                                                                                                
   K300500WUTILIZATION BEYOND SIMPLE LOCOMOTION.                                                                                                                                                                                                                                                                                
   K400100VLOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 4 - HAS THE ABILITY OR POTENTIAL    Lwr ext prost functnl lvl 4                                                                                                               C                                      1993010119970101        N                           
   K400200WFOR PROSTHETIC AMBULATION THAT EXCEEDS THE BASIC AMBULATION SKILLS, EXHIBITING                                                                                                                                                                                                                                       
   K400300WHIGH IMPACT, STRESS, OR ENERGY LEVELS, TYPICAL OF THE PROSTHETIC DEMANDS OF THE                                                                                                                                                                                                                                      
   K400400WCHILD, ACTIVE ADULT, OR ATHLETE.                                                                                                                                                                                                                                                                                     
   KA00100VADD ON OPTION/ACCESSORY FOR WHEELCHAIR                                          Wheelchair add-on option/acc                                                                                                              C                                      1994010119970101        N                           
   KB00100VBENEFICIARY REQUESTED UPGRADE FOR ABN, MORE THAN 4 MODIFIERS IDENTIFIED ON CLAIM>4 modifiers on claim                                                                                                                     C                                      2003010120030101        N                           
   KC00100VREPLACEMENT OF SPECIAL POWER WHEELCHAIR INTERFACE                               Repl special pwr wc intrface                                                                                                              C                                      2005010120050101        N                           
   KD00100VDRUG OR BIOLOGICAL INFUSED THROUGH DME                                          Drug/biological DME infused                                                                                                               C                                      2004010120040101        N                           
   KF00100VITEM DESIGNATED BY FDA AS CLASS III DEVICE                                      FDA class III device                                                                                                                      C                                      2004040120040401        N                           
   KH00100VDMEPOS ITEM, INITIAL CLAIM, PURCHASE OR FIRST MONTH RENTAL                      DMEPOS ini clm, pur/1 mo rnt                                                                                                              C                                      1994010119970101        N                           
   KI00100VDMEPOS ITEM, SECOND OR THIRD MONTH RENTAL                                       DMEPOS 2nd or 3rd mo rental                                                                                                               C                                      1994010119970101        N                           
   KJ00100VDMEPOS ITEM, PARENTERAL ENTERAL NUTRITION (PEN) PUMP OR CAPPED RENTAL, MONTHS   DMEPOS PEN pmp or 4-15mo rnt                                                                                                              C                                      1994010119970101        N                           
   KJ00200WFOUR TO FIFTEEN                                                                                                                                                                                                                                                                                                      
   KM00100VREPLACEMENT OF FACIAL PROSTHESIS INCLUDING NEW IMPRESSION/MOULAGE               Rplc facial prosth new imp                                                                                                                C                                      1996010120010101        N                           
   KN00100VREPLACEMENT OF FACIAL PROSTHESIS USING PREVIOUS MASTER MODEL                    Rplc facial prosth old mod                                                                                                                C                                      1996010120010101        N                           
   KO00100VSINGLE DRUG UNIT DOSE FORMULATION                                               Single drug unit dose form                                                                                                                C                                      1997040119970401        N                           
   KP00100VFIRST DRUG OF A MULTIPLE DRUG UNIT DOSE FORMULATION                             First drug of multi drug u d                                                                                                              C                                      1997040119970401        N                           
   KQ00100VSECOND OR SUBSEQUENT DRUG OF A MULTIPLE DRUG UNIT DOSE FORMULATION              2nd/subsqnt drg multi drg ud                                                                                                              C                                      1997040119970401        N                           
   KR00100VRENTAL ITEM, BILLING FOR PARTIAL MONTH                                          Rental item partial month                                                                                                                 C                                      2002010120020101        N                           
   KS00100VGLUCOSE MONITOR SUPPLY FOR DIABETIC BENEFICIARY NOT TREATED WITH INSULIN        Glucose monitor supply                                                                                                                    D                      0074            1998100119981001        N                           
   KX00100VSPECIFIC REQUIRED DOCUMENTATION ON FILE                                         Documentation on file                                                                                                                     C                                      2002070120020701        N                           
   KZ00100VNEW COVERAGE NOT IMPLEMENTED BY MANAGED CARE                                    New cov not implement by m+c                                                                                                              C                                      2003100120031001        N                           
   LC00100VLEFT CIRCUMFLEX CORONARY ARTERY                                                 Lft circum coronary artery                                                                                                                C                                      1997010119970101        N                           
   LD00100VLEFT ANTERIOR DESCENDING CORONARY ARTERY                                        Left ant des coronary artery                                                                                                              C                                      1997010119970101        N                           
   LL00100VLEASE/RENTAL (USE THE 'LL' MODIFIER WHEN DME EQUIPMENT RENTAL IS TO BE APPLIED  Lease/rental (appld to pur)                                                                                                               C                                      1984010119970101        N                           
   LL00200WAGAINST THE PURCHASE PRICE)                                                                                                                                                                                                                                                                                          
   LR00100VLABORATORY ROUND TRIP                                                           Laboratory round trip                                                                                                                     C                                      1987010119970101        N                           
   LS00100VFDA-MONITORED INTRAOCULAR LENS IMPLANT                                          FDA-monitored IOL implant            65-7                                                                                                 D                                      1991010119970101        N                           
   LT00100VLEFT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE LEFT SIDE OF THE BODY)  Left side                                                                                                                                 C                                      1984010119970101        N                           
   MS00100VSIX MONTH MAINTENANCE AND SERVICING FEE FOR REASONABLE AND NECESSARY PARTS AND  6-mo maint/svc fee parts/lbr                                                                                                              C                                      1989010119970101        N                           
   MS00200WLABOR WHICH ARE NOT COVERED UNDER ANY MANUFACTURER OR SUPPLIER WARRANTY                                                                                                                                                                                                                                              
   NR00100VNEW WHEN RENTED (USE THE 'NR' MODIFIER WHEN DME WHICH WAS NEW AT THE TIME OF    New when rented                                                                                                                           C                                      1984010119970101        N                           
   NR00200WRENTAL IS SUBSEQUENTLY PURCHASED)                                                                                                                                                                                                                                                                                    
   NU00100VNEW EQUIPMENT                                                                   New equipment                                                                                                                             C                                      1984010119970101        N                           
   P100100VA NORMAL HEALTHY PATIENT                                                        Normal healthy patient                                                                                                                    C                                      2006010120060101        A                           
   P200100VA PATIENT WITH MILD SYSTEMIC DISEASE                                            Patient w/mild syst disease                                                                                                               C                                      2006010120060101        A                           
   P300100VA PATIENT WITH SEVERE SYSTEMIC DISEASE                                          Patient w/severe sys disease                                                                                                              C                                      2006010120060101        A                           
   P400100VA PATIENT WITH SEVERE SYSTEMIC DISEASE THAT IS A CONSTANT THREAT TO LIFE        Pt w/sev sys dis threat life                                                                                                              C                                      2006010120060101        A                           
   P500100VA MORIBUND PATIENT WHO IS NOT EXPECTED TO SURVIVE WITHOUT THE OPERATION         Pt not expect surv w/o oper                                                                                                               C                                      2006010120060101        A                           
   P600100VA DECLARED BRAIN-DEAD PATIENT WHOSE ORGANS ARE BEING REMOVED FOR DONOR PURPOSES Brain-dead pt organs removed                                                                                                              C                                      2006010120060101        A                           
   PL00100VPROGRESSIVE ADDITION LENSES                                                     Progressive addition lenses                                                                                                               C                                      1989010119970101        N                           
   Q200100VHCFA/ORD DEMONSTRATION PROJECT PROCEDURE/SERVICE                                HCFA/ORD demo procedure/svc                                                                                                               C                      0046            1992010119970101        N                           
   Q300100VLIVE KIDNEY DONOR SURGERY AND RELATED SERVICES                                  Liver donor surgery/services                                                                                                              C                                      1995010120030101        N                           
   Q400100VSERVICE FOR ORDERING/REFERRING PHYSICIAN QUALIFIES AS A SERVICE EXEMPTION       Svc exempt - ordrg/rfrng MD                                                                                                               C                                      1994010119970101        N                           
   Q500100VSERVICE FURNISHED BY A SUBSTITUTE PHYSICIAN UNDER A RECIPROCAL BILLING          Subst MD svc, recip bill arr                           3060.6                                                                             D                                      1993010119970101        N                           
   Q500200WARRANGEMENT                                                                                                                                                                                                                                                                                                          
   Q600100VSERVICE FURNISHED BY A LOCUM TENENS PHYSICIAN                                   Locum tenens MD service                                3060.7                                                                             D                                      1993010119970101        N                           
   Q700100VONE CLASS A FINDING                                                             One Class A finding                                                                                                                       C                                      1995010119970101        N                           
   Q800100VTWO CLASS B FINDINGS                                                            Two Class B findings                                                                                                                      C                                      1995010119970101        N                           
   Q900100VONE CLASS B AND TWO CLASS C FINDINGS                                            1 Class B & 2 Class C fndngs                                                                                                              C                                      1995010119970101        N                           
   QA00100VFDA INVESTIGATIONAL DEVICE EXEMPTION                                            FDA investigational device                                                                                                                C                                      1996010119961001        N                           
   QB00100VPHYSICIAN PROVIDING SERVICE IN A RURAL HPSA                                     MD prvdg svc in rural HPSA                             3350.3                                                                             D                      0069            199201012006010120051231D                           
   QC00100VSINGLE CHANNEL MONITORING                                                       Single channel monitoring                                                                                                                 C                                      1989010119970101        N                           
   QD00100VRECORDING AND STORAGE IN SOLID STATE MEMORY BY A DIGITAL RECORDER               Rcrdg/strg in sld st memory                                                                                                               C                                      1989010119970101        N                           
   QE00100VPRESCRIBED AMOUNT OF OXYGEN IS LESS THAN 1 LITER PER MINUTE (LPM)               Prescribed oxygen < 1 LPM                                                                                                                 C                                      1989010119970101        N                           
   QF00100VPRESCRIBED AMOUNT OF OXYGEN EXCEEDS 4 LITERS PER MINUTE (LPM) AND PORTABLE      Prscrbd oxygen >4 LPM & port                                                                                                              C                                      1989010119970101        N                           
   QF00200WOXYGEN IS PRESCRIBED                                                                                                                                                                                                                                                                                                 
   QG00100VPRESCRIBED AMOUNT OF OXYGEN IS GREATER THAN 4 LITERS PER MINUTE(LPM)            Prescribed oxygen > 4 LPM                                                                                                                 C                                      1989010119970101        N                           
   QH00100VOXYGEN CONSERVING DEVICE IS BEING USED WITH AN OXYGEN DELIVERY SYSTEM           Oxygen cnsrvg dvc w del sys                                                                                                               C                                      1989010119970101        N                           
   QJ00100VSERVICES/ITEMS PROVIDED TO A PRISONER OR PATIENT IN STATE OR LOCAL CUSTODY,     Patient in state/locl custod                                                                                                              D                      0111            2003010120030101        N                           
   QJ00200WHOWEVER THE STATE OR LOCAL GOVERNMENT, AS APPLICABLE, MEETS THE REQUIREMENTS IN                                                                                                                                                                                                                                      
   QJ00300W42 CFR 411.4 (B)                                                                                                                                                                                                                                                                                                     
   QK00100VMEDICAL DIRECTION OF TWO, THREE, OR FOUR CONCURRENT ANESTHESIA PROCEDURES       Med dir 2-4 cncrnt anes proc                           3350.5                                                                             D                                      1995010120010101        N                           
   QK00200WINVOLVING QUALIFIED INDIVIDUALS                                                                                                                                                                                                                                                                                      
   QL00100VPATIENT PRONOUNCED DEAD AFTER AMBULANCE CALLED                                  Patient died after amb call                                                                                                               C                                      1999010119990101        N                           
   QM00100VAMBULANCE SERVICE PROVIDED UNDER ARRANGEMENT BY A PROVIDER OF SERVICES          Ambulance arr by provider                                                                                                                 C                                      1996010119990101        N                           
   QN00100VAMBULANCE SERVICE FURNISHED DIRECTLY BY A PROVIDER OF SERVICES                  Ambulance furn by provider                                                                                                                C                                      1996010119990101        N                           
   QP00100VDOCUMENTATION IS ON FILE SHOWING THAT THE LABORATORY TEST(S) WAS ORDERED        Individually ordered lab tst                           7517.1                                                                             D                                      1996010119960301        N                           
   QP00200WINDIVIDUALLY OR ORDERED AS A CPT-RECOGNIZED PANEL OTHER THAN AUTOMATED PROFILE                                                                                                                                                                                                                                       
   QP00300WCODES 80002-80019, G0058, G0059, AND G0060.                                                                                                                                                                                                                                                                          
   QQ00100VCLAIM SUBMITTED WITH A WRITTEN STATEMENT OF INTENT                              SOI submitted                                                                                                                             C                                      200010012006010120051231D                           
   QR00100VITEM OR SERVICE PROVIDED IN A MEDICARE SPECIFIED STUDY                          Item/serv in medicare study                                                                                                               D                      0122            2005010120050101        A                           
   QS00100VMONITORED ANESTHESIA CARE SERVICE                                               Monitored anesthesia care            15018I                                                                                               D                                      1990010119960701        N                           
   QT00100VRECORDING AND STORAGE ON TAPE BY AN ANALOG TAPE RECORDER                        Rcrdg/strg tape analog recdr                                                                                                              C                                      1989010119970101        N                           
   QU00100VPHYSICIAN PROVIDING SERVICE IN AN URBAN HPSA                                    MD providing svc urban HPSA                            3350.3                                                                             D                      0069            199101012006010120051231D                           
   QV00100VITEM OR SERVICE PROVIDED AS ROUTINE CARE IN A MEDICARE QUALIFYING CLINICAL TRIALItem or service provided             30-1                                                                                                 D                                      2000091920000919        N                           
   QW00100VCLIA WAIVED TEST                                                                CLIA waived test                                                                                                                          C                                      1996010119961001        N                           
   QX00100VCRNA SERVICE: WITH MEDICAL DIRECTION BY A PHYSICIAN                             CRNA svc w/ MD med direction                                                                                                              C                                      1993010119970101        N                           
   QY00100VMEDICAL DIRECTION OF ONE CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) BY AN    Medically directed CRNA                                3350.5                                                                             D                                      1998010120010101        N                           
   QY00200WANESTHESIOLOGIST                                                                                                                                                                                                                                                                                                     
   QZ00100VCRNA SERVICE: WITHOUT MEDICAL DIRECTION BY A PHYSICIAN                          CRNA svc w/o med dir by MD                                                                                                                C                                      1993010119970101        N                           
   RC00100VRIGHT CORONARY ARTERY                                                           Right coronary artery                                                                                                                     C                                      1997010119970101        N                           
   RD00100VDRUG PROVIDED TO BENEFICIARY, BUT NOT ADMINISTERED "INCIDENT-TO"                Drug admin not incident-to                                                                                                                C                                      2004010120040101        N                           
   RP00100VREPLACEMENT AND REPAIR -RP MAY BE USED TO INDICATE REPLACEMENT OF DME, ORTHOTIC Replacement & repair(DMEPOS)                                                                                                              C                                      1984010119970101        N                           
   RP00200WAND PROSTHETIC DEVICES WHICH HAVE BEEN IN USE FOR SOMETIME.  THE CLAIM SHOWS                                                                                                                                                                                                                                         
   RP00300WTHE CODE FOR THE PART, FOLLOWED BY THE 'RP' MODIFIER AND THE CHARGE FOR THE                                                                                                                                                                                                                                          
   RP00400WPART.                                                                                                                                                                                                                                                                                                                
   RR00100VRENTAL (USE THE 'RR' MODIFIER WHEN DME IS TO BE RENTED)                         Rental (DME)                                                                                                                              C                                      1984010119970101        N                           
   RT00100VRIGHT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE RIGHT SIDE OF THE BODY)Right side                                                                                                                                C                                      1984010119970101        N                           
   SA00100VNURSE PRACTITIONER RENDERING SERVICE IN COLLABORATION WITH A PHYSICIAN          Nurse practitioner w physici                                                                                                              I                                      2001070120010701        N                           
   SB00100VNURSE MIDWIFE                                                                   Nurse midwife                                                                                                                             I                                      2001070120010701        N                           
   SC00100VMEDICALLY NECESSARY SERVICE OR SUPPLY                                           Medically necessary serv/sup                                                                                                              I                                      2001070120010701        N                           
   SD00100VSERVICES PROVIDED BY REGISTERED NURSE WITH SPECIALIZED, HIGHLY TECHNICAL HOME   Serv by home infusion RN                                                                                                                  I                                      2001070120010701        N                           
   SD00200WINFUSION TRAINING                                                                                                                                                                                                                                                                                                    
   SE00100VSTATE AND/OR FEDERALLY-FUNDED PROGRAMS/SERVICES                                 State/fed funded program/ser                                                                                                              I                                      2001070120010701        N                           
   SF00100VSECOND OPINION ORDERED BY A PROFESSIONAL REVIEW ORGANIZATION (PRO) PER SECTION  2nd opinion ordered by PRO                                                                                                                C                                      1987010119970101        N                           
   SF00200W9401, P.L. 99-272 (100% REIMBURSEMENT - NO MEDICARE DEDUCTIBLE OR COINSURANCE)                                                                                                                                                                                                                                       
   SG00100VAMBULATORY SURGICAL CENTER (ASC) FACILITY SERVICE                               ASC facility service                                                                                                                      C                                      1992010119970101        N                           
   SH00100VSECOND CONCURRENTLY ADMINISTERED INFUSION THERAPY                               2nd concurrent infusion ther                                                                                                              I                                      2001070120010701        N                           
   SJ00100VTHIRD OR MORE CONCURRENTLY ADMINISTERED INFUSION THERAPY                        3rd concurrent infusion ther                                                                                                              I                                      2001070120010701        N                           
   SK00100VMEMBER OF HIGH RISK POPULATION (USE ONLY WITH CODES FOR IMMUNIZATION)           High risk population                                                                                                                      I                                      2002040120020401        N                           
   SL00100VSTATE SUPPLIED VACCINE                                                          State supplied vaccine                                                                                                                    I                                      2002040120020401        N                           
   SM00100VSECOND SURGICAL OPINION                                                         Second opinion                                                                                                                            I                                      2002070120020701        N                           
   SN00100VTHIRD SURGICAL OPINION                                                          Third opinion                                                                                                                             I                                      2002070120020701        N                           
   SQ00100VITEM ORDERED BY HOME HEALTH                                                     Item ordered by home health                                                                                                               I                                      2002100120021001        N                           
   SS00100VHOME INFUSION SERVICES PROVIDED IN THE INFUSION SUITE OF THE IV THERAPY PROVIDERHIT in infusion suite                                                                                                                     I                                      2004100120041001        N                           
   ST00100VRELATED TO TRAUMA OR INJURY                                                     Related to trauma or injury                                                                                                               I                                      2003010120030101        N                           
   SU00100VPROCEDURE PERFORMED IN PHYSICIAN'S OFFICE (TO DENOTE USE OF FACILITY AND        Performed in phys office                                                                                                                  I                                      2003010120030101        N                           
   SU00200WEQUIPMENT)                                                                                                                                                                                                                                                                                                           
   SV00100VPHARMACEUTICALS DELIVERED TO PATIENT'S HOME BUT NOT UTILIZED                    Drugs delivered not used                                                                                                                  I                                      2003010120030101        N                           
   SW00100VSERVICES PROVIDED BY A CERTIFIED DIABETIC EDUCATOR                              Serv by cert diab educator                                                                                                                C                                      2004040120040401        N                           
   SY00100VPERSONS WHO ARE IN CLOSE CONTACT WITH MEMBER OF HIGH-RISK POPULATION (USE ONLY  Contact w/high-risk pop                                                                                                                   I                                      2005010120050101        N                           
   SY00200WWITH CODES FOR IMMUNIZATION)                                                                                                                                                                                                                                                                                         
   T100100VLEFT FOOT, SECOND DIGIT                                                         Left foot, second digit                                                                                                                   C                                      1995010119990101        N                           
   T200100VLEFT FOOT, THIRD DIGIT                                                          Left foot, third digit                                                                                                                    C                                      1995010119990101        N                           
   T300100VLEFT FOOT, FOURTH DIGIT                                                         Left foot, fourth digit                                                                                                                   C                                      1995010119990101        N                           
   T400100VLEFT FOOT, FIFTH DIGIT                                                          Left foot, fifth digit                                                                                                                    C                                      1995010119990101        N                           
   T500100VRIGHT FOOT, GREAT TOE                                                           Right foot, great toe                                                                                                                     C                                      1995010119990101        N                           
   T600100VRIGHT FOOT, SECOND DIGIT                                                        Right foot, second digit                                                                                                                  C                                      1995010119990101        N                           
   T700100VRIGHT FOOT, THIRD DIGIT                                                         Right foot, third digit                                                                                                                   C                                      1995010119990101        N                           
   T800100VRIGHT FOOT, FOURTH DIGIT                                                        Right foot, fourth digit                                                                                                                  C                                      1995010119990101        N                           
   T900100VRIGHT FOOT, FIFTH DIGIT                                                         Right foot, fifth digit                                                                                                                   C                                      1995010119990101        N                           
   TA00100VLEFT FOOT, GREAT TOE                                                            Left foot, great toe                                                                                                                      C                                      1995010119990101        N                           
   TC00100VTECHNICAL COMPONENT.  UNDER CERTAIN CIRCUMSTANCES, A CHARGE MAY BE MADE FOR THE Technical component                                                                                                                       C                                      1984010119970101        N                           
   TC00200WTECHNICAL COMPONENT ALONE.  UNDER THOSE CIRCUMSTANCES THE TECHNICAL COMPONENT                                                                                                                                                                                                                                        
   TC00300WCHARGE IS IDENTIFIED BY ADDING MODIFIER 'TC' TO THE USUAL PROCEDURE NUMBER.                                                                                                                                                                                                                                          
   TC00400WTECHNICAL COMPONENT CHARGES ARE INSTITUTIONAL CHARGES AND NOT BILLED SEPARATELY                                                                                                                                                                                                                                      
   TC00500WBY PHYSICIANS.  HOWEVER, PORTABLE X-RAY SUPPLIERS ONLY BILL FOR TECHNICAL                                                                                                                                                                                                                                            
   TC00600WCOMPONENT AND SHOULD UTILIZE MODIFIER TC.  THE CHARGE DATA FROM PORTABLE X-RAY                                                                                                                                                                                                                                       
   TC00700WSUPPLIERS WILL THEN BE USED TO BUILD CUSTOMARY AND PREVAILING PROFILES.                                                                                                                                                                                                                                              
   TD00100VRN                                                                              RN                                                                                                                                        I                                      2001070120010701        N                           
   TE00100VLPN/LVN                                                                         LPN/LVN                                                                                                                                   I                                      2001070120010701        N                           
   TF00100VINTERMEDIATE LEVEL OF CARE                                                      Intermediate level of care                                                                                                                I                                      2001070120010701        N                           
   TG00100VCOMPLEX/HIGH TECH LEVEL OF CARE                                                 Complex/High Tech level care                                                                                                              I                                      2001070120010701        N                           
   TH00100VOBSTETRICAL TREATMENT/SERVICES, PRENATAL OR POSTPARTUM                          OB TX/Srvcs prenatl/postpart                                                                                                              I                                      2001070120010701        N                           
   TJ00100VPROGRAM GROUP, CHILD AND/OR ADOLESCENT                                          Child/adolescent program gp                                                                                                               I                                      2001070120010701        N                           
   TK00100VEXTRA PATIENT OR PASSENGER, NON-AMBULANCE                                       Extra patient or passenger                                                                                                                I                                      2002040120020401        N                           
   TL00100VEARLY INTERVENTION/INDIVIDUALIZED FAMILY SERVICE PLAN (IFSP)                    Early intervention IFSP                                                                                                                   I                                      2002040120020401        N                           
   TM00100VINDIVIDUALIZED EDUCATION PROGRAM (IEP)                                          Individualized ed prgrm(IEP)                                                                                                              I                                      2002040120020401        N                           
   TN00100VRURAL/OUTSIDE PROVIDERS' CUSTOMARY SERVICE AREA                                 Rural/out of service area                                                                                                                 I                                      2002040120020401        N                           
   TP00100VMEDICAL TRANSPORT, UNLOADED VEHICLE                                             Med transprt unloaded vehicl                                                                                                              I                                      2002040120020401        N                           
   TQ00100VBASIC LIFE SUPPORT TRANSPORT BY A VOLUNTEER AMBULANCE PROVIDER                  BLS by volunteer amb providr                                                                                                              I                                      2002040120020401        N                           
   TR00100VSCHOOL-BASED INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES PROVIDED OUTSIDE   School-based IEP out of dist                                                                                                              I                                      2002070120020701        N                           
   TR00200WTHE PUBLIC SCHOOL DISTRICT RESPONSIBLE FOR THE STUDENT                                                                                                                                                                                                                                                               
   TS00100VFOLLOW-UP SERVICE                                                               Follow-up service                                                                                                                         C                                      2002100120060101        F                           
   TT00100VINDIVIDUALIZED SERVICE PROVIDED TO MORE THAN ONE PATIENT IN SAME SETTING        Additional patient                                                                                                                        I                                      2002100120021001        N                           
   TU00100VSPECIAL PAYMENT RATE, OVERTIME                                                  Overtime payment rate                                                                                                                     I                                      2003010120030101        N                           
   TV00100VSPECIAL PAYMENT RATES, HOLIDAYS/WEEKENDS                                        Holiday/weekend payment rate                                                                                                              I                                      2003010120030101        N                           
   TW00100VBACK-UP EQUIPMENT                                                               Back-up equipment                                                                                                                         I                                      2003010120030101        N                           
   U100100VMEDICAID LEVEL OF CARE 1, AS DEFINED BY EACH STATE                              M/caid care lev 1 state def                                                                                                               I                                      2002070120020701        N                           
   U200100VMEDICAID LEVEL OF CARE 2, AS DEFINED BY EACH STATE                              M/caid care lev 2 state def                                                                                                               I                                      2002070120020701        N                           
   U300100VMEDICAID LEVEL OF CARE 3, AS DEFINED BY EACH STATE                              M/caid care lev 3 state def                                                                                                               I                                      2002070120020701        N                           
   U400100VMEDICAID LEVEL OF CARE 4, AS DEFINED BY EACH STATE                              M/caid care lev 4 state def                                                                                                               I                                      2002070120020701        N                           
   U500100VMEDICAID LEVEL OF CARE 5, AS DEFINED BY EACH STATE                              M/caid care lev 5 state def                                                                                                               I                                      2002070120020701        N                           
   U600100VMEDICAID LEVEL OF CARE 6, AS DEFINED BY EACH STATE                              M/caid care lev 6 state def                                                                                                               I                                      2002070120020701        N                           
   U700100VMEDICAID LEVEL OF CARE 7, AS DEFINED BY EACH STATE                              M/caid care lev 7 state def                                                                                                               I                                      2002070120020701        N                           
   U800100VMEDICAID LEVEL OF CARE 8, AS DEFINED BY EACH STATE                              M/caid care lev 8 state def                                                                                                               I                                      2002070120020701        N                           
   U900100VMEDICAID LEVEL OF CARE 9, AS DEFINED BY EACH STATE                              M/caid care lev 9 state def                                                                                                               I                                      2002070120020701        N                           
   UA00100VMEDICAID LEVEL OF CARE 10, AS DEFINED BY EACH STATE                             M/caid care lev 10 state def                                                                                                              I                                      2002070120020701        N                           
   UB00100VMEDICAID LEVEL OF CARE 11, AS DEFINED BY EACH STATE                             M/caid care lev 11 state def                                                                                                              I                                      2002070120020701        N                           
   UC00100VMEDICAID LEVEL OF CARE 12, AS DEFINED BY EACH STATE                             M/caid care lev 12 state def                                                                                                              I                                      2002070120020701        N                           
   UD00100VMEDICAID LEVEL OF CARE 13, AS DEFINED BY EACH STATE                             M/caid care lev 13 state def                                                                                                              I                                      2002070120020701        N                           
   UE00100VUSED DURABLE MEDICAL EQUIPMENT                                                  Used durable med equipment                                                                                                                C                                      1984010119970101        N                           
   UF00100VSERVICES PROVIDED IN THE MORNING                                                Services provided, morning                                                                                                                I                                      2003040120030401        N                           
   UG00100VSERVICES PROVIDED IN THE AFTERNOON                                              Services provided, afternoon                                                                                                              I                                      2003040120030401        N                           
   UH00100VSERVICES PROVIDED IN THE EVENING                                                Services provided, evening                                                                                                                I                                      2003040120030401        N                           
   UJ00100VSERVICES PROVIDED AT NIGHT                                                      Services provided, night                                                                                                                  I                                      2003040120030401        N                           
   UK00100VSERVICES PROVIDED ON BEHALF OF THE CLIENT TO SOMEONE OTHER THAN THE CLIENT      Svc on behalf client-collat                                                                                                               I                                      2003040120030401        N                           
   UK00200W(COLLATERAL RELATIONSHIP)                                                                                                                                                                                                                                                                                            
   UN00100VTWO PATIENTS SERVED                                                             Two patients served                                                                                                                       C                      0114            2004010120040101        N                           
   UP00100VTHREE PATIENTS SERVED                                                           Three patients served                                                                                                                     C                      0114            2004010120040101        N                           
   UQ00100VFOUR PATIENTS SERVED                                                            Four patients served                                                                                                                      C                      0114            2004010120040101        N                           
   UR00100VFIVE PATIENTS SERVED                                                            Five patients served                                                                                                                      C                      0114            2004010120040101        N                           
   US00100VSIX OR MORE PATIENTS SERVED                                                     Six or more patients served                                                                                                               C                      0114            2004010120040101        N                           
   VP00100VAPHAKIC PATIENT                                                                 Aphakic patient                                                                                                                           C                                      1984010119970101        N                           
A002100100PAMBULANCE SERVICE, OUTSIDE STATE PER MILE, TRANSPORT (MEDICAID ONLY)            Outside state ambulance serv00      9                                                                            A0030                    I                          O1A D       1985010119960910        N                           
A008000100PNON-EMERGENCY TRANSPORTATION, PER MILE - VEHICLE PROVIDED BY VOLUNTEER          Noninterest escort in non er00      9                                                                                                     I                          O1A D       1982010120030101        N                           
A008000200Q(INDIVIDUAL OR ORGANIZATION), WITH NO VESTED INTEREST                                                                                                                                                                                                                                                                
A009000100PNON-EMERGENCY TRANSPORTATION, PER MILE - VEHICLE PROVIDED BY INDIVIDUAL (FAMILY Interest escort in non er   00      9                                                                                                     I                          O1A D       1982010120030101        N                           
A009000200QMEMBER, SELF, NEIGHBOR) WITH VESTED INTEREST                                                                                                                                                                                                                                                                         
A010000100PNON-EMERGENCY TRANSPORTATION; TAXI                                              Nonemergency transport taxi 00      9                                                                                                     I                          O1A D       1982010120030101        N                           
A011000100PNON-EMERGENCY TRANSPORTATION AND BUS, INTRA OR INTER STATE CARRIER              Nonemergency transport bus  00      9                                                                                                     I                          O1A D       1984010119950101        N                           
A012000100PNON-EMERGENCY TRANSPORTATION: MINI-BUS, MOUNTAIN AREA TRANSPORTS, OR OTHER      Noner transport mini-bus    00      9                                                                                                     I                          O1A D       1982010120030101        N                           
A012000200QTRANSPORTATION SYSTEMS                                                                                                                                                                                                                                                                                               
A013000100PNON-EMERGENCY TRANSPORTATION: WHEEL-CHAIR VAN                                   Noner transport wheelch van 00      9                                                                                                     I                          O1A D       1982010119950101        N                           
A014000100PNON-EMERGENCY TRANSPORTATION AND AIR TRAVEL (PRIVATE OR COMMERCIAL) INTRA OR    Nonemergency transport air  00      9                                                                                                     I                          O1A D       1985010119960910        N                           
A014000200QINTER STATE                                                                                                                                                                                                                                                                                                          
A016000100PNON-EMERGENCY TRANSPORTATION: PER MILE - CASE WORKER OR SOCIAL WORKER           Noner transport case worker 00      9                                                                                                     I                          O1A D       1984010119950101        N                           
A017000100PTRANSPORTATION ANCILLARY:  PARKING FEES, TOLLS, OTHER                           Transport parking fees/tolls00      9                                                                                                     I                          O1A D       1982010120030101        N                           
A018000100PNON-EMERGENCY TRANSPORTATION: ANCILLARY:  LODGING-RECIPIENT                     Noner transport lodgng recip00      9                                                                                                     I                          O1A D       1982010119950101        N                           
A019000100PNON-EMERGENCY TRANSPORTATION: ANCILLARY:  MEALS-RECIPIENT                       Noner transport meals recip 00      9                                                                                                     I                          O1A D       1984010119950101        N                           
A020000100PNON-EMERGENCY TRANSPORTATION: ANCILLARY:  LODGING ESCORT                        Noner transport lodgng escrt00      9                                                                                                     I                          O1A D       1982010119950101        N                           
A021000100PNON-EMERGENCY TRANSPORTATION: ANCILLARY:  MEALS-ESCORT                          Noner transport meals escort00      9                                                                                                     I                          O1A D       1984010119950101        N                           
A022500100PAMBULANCE SERVICE, NEONATAL TRANSPORT, BASE RATE, EMERGENCY TRANSPORT, ONE WAY  Neonatal emergency transport00      9                                                                                                     I                          O1A D       1985010120030401        N                           
A038000100PBLS MILEAGE (PER MILE)                                                          Basic life support mileage  00      9                                                                            A0425                    I                          O1A D       1995010120030101        N                           
A038200100PBLS ROUTINE DISPOSABLE SUPPLIES                                                 Basic support routine suppls52      A                                                                                                     C                          O1A D       1995010119950101        N                           
A038400100PBLS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; DEFIBRILLATION (USED BY ALS        Bls defibrillation supplies 52      A                                                                                                     C                          O1A D       1995010119950101        N                           
A038400200QAMBULANCES AND BLS AMBULANCES IN JURISDICTIONS WHERE DEFIBRILLATION IS                                                                                                                                                                                                                                               
A038400300QPERMITTED IN BLS AMBULANCES)                                                                                                                                                                                                                                                                                         
A039000100PALS MILEAGE (PER MILE)                                                          Advanced life support mileag00      9                                                                            A0425                    I                          O1A D       1995010120030101        N                           
A039200100PALS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; DEFIBRILLATION (TO BE USED ONLY IN Als defibrillation supplies 52      A                                                                                                     C                          O1A D       1995010119950101        N                           
A039200200QJURISDICTIONS WHERE DEFIBRILLATION CANNOT BE PERFORMED IN BLS AMBULANCES)                                                                                                                                                                                                                                            
A039400100PALS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; IV DRUG THERAPY                    Als IV drug therapy supplies52      A                                                                                                     C                          O1A D       1995010119950101        N                           
A039600100PALS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; ESOPHAGEAL INTUBATION              Als esophageal intub suppls 52      A                                                                                                     C                          O1A D       1995010119950101        N                           
A039800100PALS ROUTINE DISPOSABLE SUPPLIES                                                 Als routine disposble suppls52      A                                                                                                     C                          O1A D       1995010119950101        N                           
A042000100PAMBULANCE WAITING TIME (ALS OR BLS), ONE HALF (1/2) HOUR INCREMENTS             Ambulance waiting 1/2 hr    52      A                                                                                                     C                          O1A D       1995010119950101        N                           
A042200100PAMBULANCE (ALS OR BLS) OXYGEN AND OXYGEN SUPPLIES, LIFE SUSTAINING SITUATION    Ambulance 02 life sustaining52      A                                                                                                     C                          O1A D       1995010119950101        N                           
A042400100PEXTRA AMBULANCE ATTENDANT, GROUND (ALS OR BLS) OR AIR (FIXED OR ROTARY WINGED); Extra ambulance attendant   52      A                                                                                                     C                          O1A D       1995010120030101        N                           
A042400200Q(REQUIRES MEDICAL REVIEW)                                                                                                                                                                                                                                                                                            
A042500100PGROUND MILEAGE, PER STATUTE MILE                                                Ground mileage              52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A042600100PAMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY TRANSPORT, LEVEL 1 (ALS Als 1                       52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A042600200Q1)                                                                                                                                                                                                                                                                                                                   
A042700100PAMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1          ALS1-emergency              52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A042700200Q(ALS1-EMERGENCY)                                                                                                                                                                                                                                                                                                     
A042800100PAMBULANCE SERVICE, BASIC LIFE SUPPORT, NON-EMERGENCY TRANSPORT, (BLS)           bls                         52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A042900100PAMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS-EMERGENCY)      BLS-emergency               52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A043000100PAMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (FIXED WING)   Fixed wing air transport    52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A043100100PAMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (ROTARY WING)  Rotary wing air transport   52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A043200100PPARAMEDIC INTERCEPT (PI), RURAL AREA, TRANSPORT FURNISHED BY A VOLUNTEER        PI volunteer ambulance co   52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A043200200QAMBULANCE COMPANY WHICH IS PROHIBITED BY STATE LAW FROM BILLING THIRD PARTY                                                                                                                                                                                                                                          
A043200300QPAYERS                                                                                                                                                                                                                                                                                                               
A043300100PADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)                                          als 2                       52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A043400100PSPECIALTY CARE TRANSPORT (SCT)                                                  Specialty care transport    52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A043500100PFIXED WING AIR MILEAGE, PER STATUTE MILE                                        Fixed wing air mileage      52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A043600100PROTARY WING AIR MILEAGE, PER STATUTE MILE                                       Rotary wing air mileage     52      A                                                                                                     C                          O1A D       2001010120010101        N                           
A080000100PAMBULANCE TRANSPORT PROVIDED BETWEEN THE HOURS OF 7PM AND 7AM                   Amb trans 7pm-7am           52      A                                                                                                     C                          O1A D       2004010120040101        N                           
A088800100PNONCOVERED AMBULANCE MILEAGE, PER MILE (E.G., FOR MILES TRAVELED BEYOND CLOSEST Noncovered ambulance mileage00      9                  2125                                                                               M                          O1A D       1995010119950101        N                           
A088800200QAPPROPRIATE FACILITY)                                                                                                                                                                                                                                                                                                
A099800100PAMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT                                  Ambulance response/treatment00      9                                                                                                     I                          O1A D       2006010120060101        A                           
A099900100PUNLISTED AMBULANCE SERVICE                                                      Unlisted ambulance service  57      A                  2120.1  2125                                                                       D                          O1A D       1987010119980101        N                           
A420600100PSYRINGE WITH NEEDLE, STERILE 1CC, EACH                                          1 CC sterile syringe&needle 00      9                                                                                                     I                          D1A S       1985010120010215        N                           
A420700100PSYRINGE WITH NEEDLE, STERILE 2CC, EACH                                          2 CC sterile syringe&needle 00      9                                                                                                     I                          D1A S       1985010120031001        N                           
A420800100PSYRINGE WITH NEEDLE, STERILE 3CC, EACH                                          3 CC sterile syringe&needle 00      9                                                                                                     I                          D1A S       1985010119990401        N                           
A420900100PSYRINGE WITH NEEDLE, STERILE 5CC OR GREATER, EACH                               5+ CC sterile syringe&needle00      9                                                                                                     I                          D1A S       1985010119990401        N                           
A421000100PNEEDLE-FREE INJECTION DEVICE, EACH                                              Nonneedle injection device  00      960-9                                                                                                 M                          D1A S       1989010119960101        N                           
A421100100PSUPPLIES FOR SELF-ADMINISTERED INJECTIONS                                       Supp for self-adm injections00      9                  2049                                                                               D                          D1A S       1993010119970101        N                           
A421200100PNON-CORING NEEDLE OR STYLET WITH OR WITHOUT CATHETER                            Non coring needle or stylet 57      A                                                                                                     C                          D1A S       1993010120000101        N                           
A421300100PSYRINGE, STERILE, 20 CC OR GREATER, EACH                                        20+ CC syringe only         00      9                                                                                                     I                          D1A S       1985010119990401        N                           
A421400100PSTERILE SALINE OR WATER, 30 CC VIAL                                             30 CC sterile water/saline  37      A                                                                                                     C                          D1F P       198401012004010120031231N                           
A421500100PNEEDLE, STERILE, ANY SIZE, EACH                                                 Sterile needle              00      9                                                                                                     I                          D1A S       1985010120060101        C                           
A421600100PSTERILE WATER, SALINE AND/OR DEXTROSE (DILUENT), 10 ML                          Sterile water/saline, 10 ml 37      A                  2049                                                                               D                          D1F 1LP     2004010120060101        C                           
A421700100PSTERILE WATER/SALINE, 500 ML                                                    Sterile water/saline, 500 ml37      A                  2049                                                                               D                          D1F 1LP     2004010120040101        N                           
A421800100PSTERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML                          Sterile saline or water     51      A                                                                                                     D                      0127O1E 1LP     2006010120060101        A                           
A422000100PREFILL KIT FOR IMPLANTABLE INFUSION PUMP                                        Infusion pump refill kit    57      A60-14                                                                                                D                      0050D1A P       1994010119980303        N                           
A422100100PSUPPLIES FOR MAINTENANCE OF DRUG INFUSION CATHETER, PER WEEK (LIST DRUG         Maint drug infus cath per wk34      A                                                                                                     C                          D1E P       1997010119970101        N                           
A422100200QSEPARATELY)                                                                                                                                                                                                                                                                                                          
A422200100PINFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST    Infusion supplies with pump 34      A                                                                                                     C                          D1E P       1997010120050101        N                           
A422200200QDRUGS SEPARATELY)                                                                                                                                                                                                                                                                                                    
A422300100PINFUSION SUPPLIES NOT USED WITH EXTERNAL INFUSION PUMP, PER CASSETTE OR BAG     Infusion supplies w/o pump  00      9                                                                                                     I                          D1E P       2005010120050101        N                           
A422300200Q(LIST DRUGS SEPARATELY)                                                                                                                                                                                                                                                                                              
A423000100PINFUSION SET FOR EXTERNAL INSULIN PUMP, NON NEEDLE CANNULA TYPE                 Infus insulin pump non needl34      A60-14                                                                                                D                          D1E P       1996010120000101        N                           
A423100100PINFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE                             Infusion insulin pump needle34      A60-14                                                                                                D                          D1E P       1996010120000101        N                           
A423200100PSYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3CC                     Syringe w/needle insulin 3cc00      960-14                                                                                                I                          D1E P       1996010120030401        N                           
A423300100PREPLACEMENT BATTERY, ALKALINE (OTHER THAN J CELL), FOR USE WITH MEDICALLY       Alkalin batt for glucose mon36      A                                                                                                     C                          D1E P       2006010120060101        A                           
A423300200QNECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                          
A423400100PREPLACEMENT BATTERY, ALKALINE, J CELL, FOR USE WITH MEDICALLY NECESSARY HOME    J-cell batt for glucose mon 36      A                                                                                                     C                          D1E P       2006010120060101        A                           
A423400200QBLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                                         
A423500100PREPLACEMENT BATTERY, LITHIUM, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD       Lithium batt for glucose mon36      A                                                                                                     C                          D1E P       2006010120060101        A                           
A423500200QGLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                                               
A423600100PREPLACEMENT BATTERY, SILVER OXIDE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD  Silvr oxide batt glucose mon36      A                                                                                                     C                          D1E P       2006010120060101        A                           
A423600200QGLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                                               
A424400100PALCOHOL OR PEROXIDE, PER PINT                                                   Alcohol or peroxide per pint00      9                                                                                                     I                          D1A LS      1985010120060101        F                           
A424500100PALCOHOL WIPES, PER BOX                                                          Alcohol wipes per box       00      9                                                                                                     I                          D1A LS      1985010120060101        F                           
A424600100PBETADINE OR PHISOHEX SOLUTION, PER PINT                                         Betadine/phisohex solution  00      9                                                                                                     I                          D1A LS      1985010120060101        F                           
A424700100PBETADINE OR IODINE SWABS/WIPES, PER BOX                                         Betadine/iodine swabs/wipes 00      9                                                                                                     I                          D1A LS      1985010120060101        F                           
A424800100PCHLORHEXIDINE CONTAINING ANTISEPTIC, 1 ML                                       Chlorhexidine antisept      52      A                                                                                                     C                          P9B L       2004010120040101        N                           
A425000100PURINE TEST OR REAGENT STRIPS OR TABLETS (100 TABLETS OR STRIPS)                 Urine reagent strips/tablets00      9                  2100                                                                               M                          T1E 9       1990010119970101        N                           
A425300100PBLOOD GLUCOSE TEST OR REAGENT STRIPS FOR HOME BLOOD GLUCOSE MONITOR, PER 50     Blood glucose/reagent strips32      A60-11                                                                                                D                          D1E P       1986010119980701        N                           
A425300200QSTRIPS                                                                                                                                                                                                                                                                                                               
A425400100PREPLACEMENT BATTERY, ANY TYPE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD      Battery for glucose monitor 32      A60-11                                                                                                D                          D1E APR     199601012006010120051231D                           
A425400200QGLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                                               
A425500100PPLATFORMS FOR HOME BLOOD GLUCOSE MONITOR, 50 PER BOX                            Glucose monitor platforms   34      A60-11                                                                                                D                          D1E P       1997010120020101        N                           
A425600100PNORMAL, LOW AND HIGH CALIBRATOR SOLUTION / CHIPS                                Calibrator solution/chips   34      A60-11                                                                                                D                          D1E P       1985010120020101        N                           
A425700100PREPLACEMENT LENS SHIELD CARTRIDGE FOR USE WITH LASER SKIN PIERCING DEVICE, EACH Replace Lensshield Cartridge34      A                                                                                                     C                          D1E P       2002010120020101        N                           
A425800100PSPRING-POWERED DEVICE FOR LANCET, EACH                                          Lancet device each          34      A60-11                                                                                                D                          D1E P       1996010120020101        N                           
A425900100PLANCETS, PER BOX OF 100                                                         Lancets per box             34      A60-11                                                                                                D                          D1E P       1985010119960101        N                           
A426000100PLEVONORGESTREL (CONTRACEPTIVE) IMPLANTS SYSTEM, INCLUDING IMPLANTS AND SUPPLIES Levonorgestrel implant      00      9                                          1862a1A                           J7306                    S                          P6C 9       199301012006010120051231D                           
A426100100PCERVICAL CAP FOR CONTRACEPTIVE USE                                              Cervical cap contraceptive  00      9                                          1862a1                                                     S                          Z2  9       1999010119990101        N                           
A426200100PTEMPORARY, ABSORBABLE LACRIMAL DUCT IMPLANT, EACH                               Temporary tear duct plug    00      9                                                                                                     D                      0052D1A 9       1994010119980101        N                           
A426300100PPERMANENT, LONG TERM, NON-DISSOLVABLE LACRIMAL DUCT IMPLANT, EACH               Permanent tear duct plug    11      A                  15030                                                                              D                          Y1  9       1994010119980101        N                           
A426500100PPARAFFIN, PER POUND                                                             Paraffin                    34      A60-9                                                                                                 D                          D1E 9       1986010120020101        N                           
A426600100PDIAPHRAGM FOR CONTRACEPTIVE USE                                                 Diaphragm                   00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
A426700100PCONTRACEPTIVE SUPPLY, CONDOM, MALE, EACH                                        Male condom                 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
A426800100PCONTRACEPTIVE SUPPLY, CONDOM, FEMALE, EACH                                      Female condom               00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
A426900100PCONTRACEPTIVE SUPPLY, SPERMICIDE (E.G., FOAM, GEL), EACH                        Spermicide                  00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
A427000100PDISPOSABLE ENDOSCOPE SHEATH, EACH                                               Disposable endoscope sheath 00      9                                                                                                     C                          P8D 9       1994010119950401        N                           
A428000100PADHESIVE SKIN SUPPORT ATTACHMENT FOR USE WITH EXTERNAL BREAST PROSTHESIS, EACH  Brst prsths adhsv attchmnt  38      A                                                                                                     C                          D1F P       2000010120000101        N                           
A428100100PTUBING FOR BREAST PUMP, REPLACEMENT                                             Replacement breastpump tube 00      9                                                                                                     I                          Z2  9       2003010120060101        F                           
A428200100PADAPTER FOR BREAST PUMP, REPLACEMENT                                            Replacement breastpump adpt 00      9                                                                                                     I                          Z2  9       2003010120060101        F                           
A428300100PCAP FOR BREAST PUMP BOTTLE, REPLACEMENT                                         Replacement breastpump cap  00      9                                                                                                     I                          Z2  9       2003010120060101        F                           
A428400100PBREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT        Replcmnt breast pump shield 00      9                                                                                                     I                          Z2  9       2003010120060101        F                           
A428500100PPOLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT                      Replcmnt breast pump bottle 00      9                                                                                                     I                          Z2  9       2003010120060101        F                           
A428600100PLOCKING RING FOR BREAST PUMP, REPLACEMENT                                       Replcmnt breastpump lok ring00      9                                                                                                     I                          Z2  9       2003010120060101        F                           
A429000100PSACRAL NERVE STIMULATION TEST LEAD, EACH                                        Sacral nerve stim test lead 00      9                                                                                                     C                          Z2  9       2001010120020101        N                           
A430000100PIMPLANTABLE ACCESS CATHETER, (E,G., VENOUS, ARTERIAL, EPIDURAL SUBARACHNOID, OR Cath impl vasc access portal11      A                  2130                                                                               D                          Y1  S       1986010120020101        N                           
A430000200QPERITONEAL, ETC.) EXTERNAL ACCESS                                                                                                                                                                                                                                                                                    
A430100100PIMPLANTABLE ACCESS TOTAL CATHETER, PORT/RESERVOIR (E.G., VENOUS, ARTERIAL,      Implantable access syst perc00      9                                                                                                     C                          D1A S       1996010120030101        N                           
A430100200QEPIDURAL, SUBARACHNOID, PERITONEAL, ETC.)                                                                                                                                                                                                                                                                            
A430500100PDISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 50 ML OR GREATER PER HOUR         Drug delivery system >=50 ML00      9                                                                                                     C                          D1A 9       1993010120060101        F                           
A430600100PDISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 5 ML OR LESS PER HOUR             Drug delivery system <=5 ML 00      9                                                                                                     C                          D1A 9       1993010120060101        F                           
A431000100PINSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CATHETER (ACCESSORIES ONLY)     Insert tray w/o bag/cath    37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A431100100PINSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,       Catheter w/o bag 2-way latex37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A431100200QTWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER OR                                                                                                                                                                                                                                                  
A431100300QHYDROPHILIC, ETC.)                                                                                                                                                                                                                                                                                                   
A431200100PINSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,       Cath w/o bag 2-way silicone 37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A431200200QTWO-WAY, ALL SILICONE                                                                                                                                                                                                                                                                                                
A431300100PINSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,       Catheter w/bag 3-way        37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A431300200QTHREE-WAY, FOR CONTINUOUS IRRIGATION                                                                                                                                                                                                                                                                                 
A431400100PINSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY  Cath w/drainage 2-way latex 37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A431400200QLATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER OR HYDROPHILIC, ETC.)                                                                                                                                                                                                                                       
A431500100PINSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, Cath w/drainage 2-way silcne37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A431500200QALL SILICONE                                                                                                                                                                                                                                                                                                         
A431600100PINSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,          Cath w/drainage 3-way       37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A431600200QTHREE-WAY, FOR CONTINUOUS IRRIGATION                                                                                                                                                                                                                                                                                 
A431900100PSTERILE WATER IRRIGATION SOLUTION, 1000 ML                                      Sterile H2O irrigation solut37      A                  2130                                                                               D                          D1F P       200101012004010120031231N                           
A432000100PIRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY PURPOSE                        Irrigation tray             37      A                  2130                                                                               D                          D1A P       1990010119920101        N                           
A432100100PTHERAPEUTIC AGENT FOR URINARY CATHETER IRRIGATION                               Cath therapeutic irrig agent37      A                  2130                                                                               D                          D1F P       1997010120030101        N                           
A432200100PIRRIGATION SYRINGE, BULB OR PISTON, EACH                                        Irrigation syringe          37      A                  2130                                                                               D                          D1F P       1990010119960101        N                           
A432300100PSTERILE SALINE IRRIGATION SOLUTION, 1000 ML.                                    Saline irrigation solution  37      A                  2130                                                                               D                          D1F P       199001012004010120031231N                           
A432400100PMALE EXTERNAL CATHETER, WITH ADHESIVE COATING, EACH                             Male ext cath w/adh coating 37      A                  2130                                                      A4349                    D                          D1F P       200101012005010120041231N                           
A432500100PMALE EXTERNAL CATHETER, WITH ADHESIVE STRIP, EACH                               Male ext cath w/adh strip   37      A                  2130                                                      A4349                    D                          D1F P       200101012005010120041231N                           
A432600100PMALE EXTERNAL CATHETER SPECIALTY TYPE WITH INTEGRAL COLLECTION CHAMBER,  EACH   Male external catheter      37      A                  2130                                                                               D                          D1F P       1990010120040101        N                           
A432700100PFEMALE EXTERNAL URINARY COLLECTION DEVICE; MEATAL CUP, EACH                     Fem urinary collect dev cup 37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A432800100PFEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH                          Fem urinary collect pouch   37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A433000100PPERIANAL FECAL COLLECTION POUCH WITH ADHESIVE, EACH                             Stool collection pouch      37      A                  2130                                                                               D                          D1F P       1990010119960101        N                           
A433100100PEXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, WITH CONNECTOR/ADAPTOR, FOR    Extension drainage tubing   37      A                  2130                                                                               D                          D1F P       2001010120030101        N                           
A433100200QUSE WITH URINARY LEG BAG OR UROSTOMY POUCH, EACH                                                                                                                                                                                                                                                                     
A433200100PLUBRICANT, INDIVIDUAL STERILE PACKET, EACH                                      Lube sterile packet         37      A                  2130                                                                               D                          D1F P       2001010120050101        N                           
A433300100PURINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT, EACH               Urinary cath anchor device  37      A                  2130                                                                               D                          D1F P       2001010120030101        N                           
A433400100PURINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH                              Urinary cath leg strap      37      A                  2130                                                                               D                          D1F P       2001010120030101        N                           
A433500100PINCONTINENCE SUPPLY; MISCELLANEOUS                                              Incontinence supply         46      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A433800100PINDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE,  Indwelling catheter latex   37      A                  2130                                                                               D                          D1F P       1990010119960101        N                           
A433800200QSILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH                                                                                                                                                                                                                                                                      
A434000100PINDWELLING CATHETER; SPECIALTY TYPE, EG; COUDE, MUSHROOM, WING, ETC.), EACH     Indwelling catheter special 37      A                  2130                                                                               D                          D1F P       1990010119960101        N                           
A434400100PINDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE, EACH                    Cath indw foley 2 way silicn37      A                  2130                                                                               D                          D1F P       1983010119960101        N                           
A434600100PINDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CONTINUOUS IRRIGATION, EACH      Cath indw foley 3 way       37      A                  2130                                                                               D                          D1F P       1983010119960101        N                           
A434700100PMALE EXTERNAL CATHETER WITH OR WITHOUT ADHESIVE, WITH OR WITHOUT ANTI-REFLUX    Male external catheter      37      A                  2130                                                                               D                          D1F P       198301012005010120041231N                           
A434700200QDEVICE; PER DOZEN                                                                                                                                                                                                                                                                                                    
A434800100PMALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION COMPARTMENT, EXTENDED WEAR,     Male ext cath extended wear 37      A                  2130                                                                               D                          D1F P       2001010120030101        N                           
A434800200QEACH (E.G., 2 PER MONTH)                                                                                                                                                                                                                                                                                             
A434900100PMALE EXTERNAL CATHETER, WITH OR WITHOUT ADHESIVE, DISPOSABLE, EACH              Disposable male external cat37      A                  2130                                                                               D                          D1A P       2005010120050101        N                           
A435100100PINTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON,   Straight tip urine catheter 37      A                  2130                                                                               D                          D1F P       1990010120020101        N                           
A435100200QSILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH                                                                                                                                                                                                                                                            
A435200100PINTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING      Coude tip urinary catheter  37      A                  2130                                                                               D                          D1F P       1990010120020101        N                           
A435200200Q(TEFLON, SILICONE, SILICONE ELASTOMERIC, OR HYDROPHILIC, ETC.), EACH                                                                                                                                                                                                                                                 
A435300100PINTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES                          Intermittent urinary cath   37      A                  2130                                                                               D                          D1F P       1997010120030101        N                           
A435400100PINSERTION TRAY WITH DRAINAGE BAG BUT WITHOUT CATHETER                           Cath insertion tray w/bag   37      A                  2130                                                                               D                          D1F P       1986010119900101        N                           
A435500100PIRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIGATION THROUGH A THREE-WAY     Bladder irrigation tubing   37      A                  2130                                                                               D                          D1F P       1984010119960101        N                           
A435500200QINDWELLING FOLEY CATHETER, EACH                                                                                                                                                                                                                                                                                      
A435600100PEXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE (NOT TO BE USED FOR CATHETER      Ext ureth clmp or compr dvc 37      A                  2130                                                                               D                          D1F P       1985010119960101        N                           
A435600200QCLAMP), EACH                                                                                                                                                                                                                                                                                                         
A435700100PBEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOUT ANTI-REFLUX DEVICE, WITH OR Bedside drainage bag        37      A                  2130                                                                               D                          D1F P       1985010119960101        N                           
A435700200QWITHOUT TUBE, EACH                                                                                                                                                                                                                                                                                                   
A435800100PURINARY DRAINAGE BAG, LEG OR ABDOMEN, VINYL, WITH OR WITHOUT TUBE, WITH STRAPS, Urinary leg or abdomen bag  37      A                  2130                                                                               D                          D1F P       1985010120020101        N                           
A435800200QEACH                                                                                                                                                                                                                                                                                                                 
A435900100PURINARY SUSPENSORY WITHOUT LEG BAG, EACH                                        Urinary suspensory w/o leg b37      A                  2130                                                                               D                          D1F P       1985010119960101        N                           
A436000100PADULT INCONTINENCE GARMENT (E.G. BRIEF, DIAPER), EACH                           Adult incontinence garment  00      960-9                                                                                                 M                          D1A 9       200201012003010120021231N                           
A436100100POSTOMY FACEPLATE, EACH                                                          Ostomy face plate           37      A                  2130                                                                               D                          D1F P       1985010119960101        N                           
A436200100PSKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH                                  Solid skin barrier          37      A                  2130                                                                               D                          D1F P       1985010119900101        N                           
A436300100POSTOMY CLAMP, ANY TYPE, REPLACEMENT ONLY, EACH                                  Ostomy clamp, replacement   37      A                                                                                                     D                      0124D1F P       2006010120060101        A                           
A436400100PADHESIVE, LIQUID OR EQUAL, ANY TYPE,  PER OZ                                    Adhesive, liquid or equal   37      A                  2130                                                                               D                          D1F P       1985010120030101        N                           
A436500100PADHESIVE REMOVER WIPES, ANY TYPE, PER 50                                        Adhesive remover wipes      37      A                  2130                                                                               D                          D1F P       1997010120030101        N                           
A436600100POSTOMY VENT, ANY TYPE, EACH                                                     Ostomy vent                 37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A436700100POSTOMY BELT, EACH                                                               Ostomy belt                 37      A                  2130A                                                                              D                          D1F P       1985010119960101        N                           
A436800100POSTOMY FILTER, ANY TYPE, EACH                                                   Ostomy filter               37      A                                                                                                     C                          D1F P       1997010119970101        N                           
A436900100POSTOMY SKIN BARRIER, LIQUID (SPRAY, BRUSH, ETC), PER OZ                         Skin barrier liquid per oz  37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A437000100POSTOMY SKIN BARRIER, PASTE, PER OZ                                              Skin barrier paste per oz   37      A                                                                                                     C                          D1A P       200001012003010120021231N                           
A437100100POSTOMY SKIN BARRIER, POWDER, PER OZ                                             Skin barrier powder per oz  37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A437200100POSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT,  STANDARD WEAR, WITH BUILT-IN     Skin barrier solid 4x4 equiv37      A                  2130                                                                               D                          D1F P       2000010120060101        C                           
A437200200QCONVEXITY, EACH                                                                                                                                                                                                                                                                                                      
A437300100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDIAN),  WITH BUILT-IN Skin barrier with flange    37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A437300200QCONVEXITY, ANY SIZE, EACH                                                                                                                                                                                                                                                                                            
A437400100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Skin barrier extended wear  37      A                                                                                                     C                          D1A P       200001012003010120021231N                           
A437400200QWITH BUILT-IN CONVEXITY, ANY SIZE, EACH                                                                                                                                                                                                                                                                              
A437500100POSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, PLASTIC, EACH                 Drainable plastic pch w fcpl37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A437600100POSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, RUBBER, EACH                  Drainable rubber pch w fcplt37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A437700100POSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, PLASTIC, EACH                    Drainable plstic pch w/o fp 37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A437800100POSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, RUBBER, EACH                     Drainable rubber pch w/o fp 37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A437900100POSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, PLASTIC, EACH                   Urinary plastic pouch w fcpl37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438000100POSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RUBBER, EACH                    Urinary rubber pouch w fcplt37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438100100POSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, PLASTIC, EACH                      Urinary plastic pouch w/o fp37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438200100POSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, HEAVY PLASTIC, EACH                Urinary hvy plstc pch w/o fp37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438300100POSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, RUBBER, EACH                       Urinary rubber pouch w/o fp 37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438400100POSTOMY FACEPLATE EQUIVALENT, SILICONE RING, EACH                                Ostomy faceplt/silicone ring37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438500100POSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITHOUT BUILT-IN   Ost skn barrier sld ext wear37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438500200QCONVEXITY, EACH                                                                                                                                                                                                                                                                                                      
A438600100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barrier w flng ex wr37      A                                                                                                     C                          D1A P       200001012003010120021231N                           
A438600200QWITHOUT BUILT-IN CONVEXITY, ANY SIZE, EACH                                                                                                                                                                                                                                                                           
A438700100POSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE), Ost clsd pouch w att st barr37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438700200QEACH                                                                                                                                                                                                                                                                                                                 
A438800100POSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, (1 PIECE), EACH   Drainable pch w ex wear barr37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438900100POSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1      Drainable pch w st wear barr37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A438900200QPIECE), EACH                                                                                                                                                                                                                                                                                                         
A439000100POSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN     Drainable pch ex wear convex37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A439000200QCONVEXITY (1 PIECE), EACH                                                                                                                                                                                                                                                                                            
A439100100POSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED (1 PIECE), EACH      Urinary pouch w ex wear barr37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A439200100POSTOMY POUCH, URINARY, WITH STANDARD WEAR BARRIER ATTACHED, WITH BUILT-IN       Urinary pouch w st wear barr37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A439200200QCONVEXITY (1 PIECE), EACH                                                                                                                                                                                                                                                                                            
A439300100POSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN       Urine pch w ex wear bar conv37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A439300200QCONVEXITY (1 PIECE), EACH                                                                                                                                                                                                                                                                                            
A439400100POSTOMY DEODORANT FOR USE IN OSTOMY POUCH, LIQUID, PER FLUID OUNCE               Ostomy pouch liq deodorant  37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A439500100POSTOMY DEODORANT FOR USE IN OSTOMY POUCH, SOLID, PER TABLET                     Ostomy pouch solid deodorant37      A                  2130                                                                               D                          D1F P       2000010120030101        N                           
A439600100POSTOMY BELT WITH PERISTOMAL HERNIA SUPPORT                                      Peristomal hernia supprt blt37      A                  2130                                                                               D                          D1F P       2001010120030101        N                           
A439700100PIRRIGATION SUPPLY; SLEEVE, EACH                                                 Irrigation supply sleeve    37      A                  2130                                                                               D                          D1F P       1990010119960101        N                           
A439800100POSTOMY IRRIGATION SUPPLY; BAG, EACH                                             Ostomy irrigation bag       37      A                  2130                                                                               D                          D1F P       1989010119970101        N                           
A439900100POSTOMY IRRIGATION SUPPLY; CONE/CATHETER, INCLUDING BRUSH                        Ostomy irrig cone/cath w brs37      A                  2130                                                                               D                          D1F P       1989010119970101        N                           
A440000100POSTOMY IRRIGATION SET                                                           Ostomy irrigation set       37      A                  2130                                                                               D                          D1F P       1982010119900101        N                           
A440200100PLUBRICANT, PER OUNCE                                                            Lubricant per ounce         37      A                  2130                                                                               D                          D1F P       1985010119950101        N                           
A440400100POSTOMY RING, EACH                                                               Ostomy ring each            37      A                  2130                                                                               D                          D1F P       1985010119950101        N                           
A440500100POSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE                         Nonpectin based ostomy paste37      A                  2130                                                                               D                          D1F P       2003010120030101        N                           
A440600100POSTOMY SKIN BARRIER, PECTIN-BASED, PASTE, PER OUNCE                             Pectin based ostomy paste   37      A                  2130                                                                               D                          D1F P       2003010120030101        N                           
A440700100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE, OR ACCORDION), EXTENDED      Ext wear ost skn barr <=4sq37      A                  2130                                                                               D                          D1F P       2003010120030101        N                           
A440700200QWEAR, WITH BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                         
A440800100POSTOMY SKIN BARRIER, WTIH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ext wear ost skn barr >4sq 37      A                  2130                                                                               D                          D1F P       2003010120030101        N                           
A440800200QWITH BUILT-IN CONVEXITY, LARGER THAN 4 X 4 INCHES, EACH                                                                                                                                                                                                                                                              
A440900100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barr convex <=4 sq i37      A                  2130                                                                               D                          D1F P       2003010120060101        S                           
A440900200QWITHOUT BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                            
A441000100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barr extnd >4 sq    37      A                  2130                                                                               D                          D1F P       2003010120060101        S                           
A441000200QWITHOUT BUILT-IN CONVEXITY, LARGER THAN 4 X 4 INCHES, EACH                                                                                                                                                                                                                                                           
A441100100POSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITH BUILT-IN      Ost skn barr extnd =4sq     37      A                                                                                                     D                      0124D1F P       2006010120060101        A                           
A441100200QCONVEXITY, EACH                                                                                                                                                                                                                                                                                                      
A441200100POSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE Ost pouch drain high output 37      A                  2130                                                                               D                      0124D1F P       2006010120060101        A                           
A441200200QSYSTEM), WITHOUT FILTER, EACH                                                                                                                                                                                                                                                                                        
A441300100POSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE 2 pc drainable ost pouch    37      A                  2130                                                                               D                          D1F P       2003010120030101        N                           
A441300200QSYSTEM), WITH FILTER, EACH                                                                                                                                                                                                                                                                                           
A441400100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT        Ost sknbar w/o conv<=4 sq in37      A                  2130                                                                               D                          D1F P       2003010120060101        S                           
A441400200QBUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                                    
A441500100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT        Ost skn barr w/o conv >4 sqi37      A                  2130                                                                               D                          D1F P       2003010120060101        S                           
A441500200QBUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH                                                                                                                                                                                                                                                                     
A441600100POSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH        Ost pch clsd w barrier/filtr37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A441700100POSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH      Ost pch w bar/bltinconv/fltr37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A441700200QFILTER (1 PIECE), EACH                                                                                                                                                                                                                                                                                               
A441800100POSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH     Ost pch clsd w/o bar w filtr37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A441900100POSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH FILTER   Ost pch for bar w flange/flt37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A441900200Q(2 PIECE), EACH                                                                                                                                                                                                                                                                                                      
A442000100POSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH    Ost pch clsd for bar w lk fl37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A442100100POSTOMY SUPPLY; MISCELLANEOUS                                                    Ostomy supply misc          00      9                                                                                                     I                          D1F P       1985010120060101        F                           
A442200100POSTOMY ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKET) FOR USE IN OSTOMY POUCH TO Ost pouch absorbent material37      A                  2130                                                                               D                          D1F P       2003010120030101        N                           
A442200200QTHICKEN LIQUID STOMAL OUTPUT, EACH                                                                                                                                                                                                                                                                                   
A442300100POSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2    Ost pch for bar w lk fl/fltr37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A442300200QPIECE), EACH                                                                                                                                                                                                                                                                                                         
A442400100POSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH     Ost pch drain w bar & filter37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A442500100POSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH       Ost pch drain for barrier fl37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A442500200QFILTER (2 PIECE SYSTEM), EACH                                                                                                                                                                                                                                                                                        
A442600100POSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE        Ost pch drain 2 piece system37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A442600200QSYSTEM), EACH                                                                                                                                                                                                                                                                                                        
A442700100POSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2 Ost pch drain/barr lk flng/f37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A442700200QPIECE SYSTEM), EACH                                                                                                                                                                                                                                                                                                  
A442800100POSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FAUCET-TYPE    Urine ost pouch w faucet/tap37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A442800200QTAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                                                       
A442900100POSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH     Urine ost pouch w bltinconv 37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A442900200QFAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                                           
A443000100POSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN       Ost urine pch w b/bltin conv37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A443000200QCONVEXITY, WITH FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                           
A443100100POSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH VALVE   Ost pch urine w barrier/tapv37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A443100200Q(1 PIECE), EACH                                                                                                                                                                                                                                                                                                      
A443200100POSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH         Os pch urine w bar/fange/tap37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A443200200QFAUCET-TYPE TAP WITH VALVE (2 PIECE), EACH                                                                                                                                                                                                                                                                           
A443300100POSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH   Urine ost pch bar w lock fln37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A443400100POSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FAUCET-TYPE Ost pch urine w lock flng/ft37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A443400200QTAP WITH VALVE (2 PIECE), EACH                                                                                                                                                                                                                                                                                       
A445000100PTAPE, NON-WATERPROOF, PER 18 SQUARE INCHES                                      Non-waterproof tape         37      A                  2130                                                                               D                          D1F LP      2003010120030101        N                           
A445200100PTAPE, WATERPROOF, PER 18 SQUARE INCHES                                          Waterproof tape             37      A                  2130                                                                               D                          D1F LP      2003010120030101        N                           
A445400100PTAPE, ALL TYPES, ALL SIZES                                                      Tape all types all sizes    37      A                  2130                                                                               D                          D1A P       198901012003010120021231N                           
A445500100PADHESIVE REMOVER OR SOLVENT (FOR TAPE, CEMENT OR OTHER ADHESIVE), PER OUNCE     Adhesive remover per ounce  37      A                  2130                                                                               D                          D1F P       1989010119950101        N                           
A445800100PENEMA BAG WITH TUBING, REUSABLE                                                 Reusable enema bag          00      9                                                                                                     I                          Z2  9       2003010120060101        F                           
A446000100PELASTIC BANDAGE, PER ROLL (E.G. COMPRESSION BANDAGE)                            Elastic compression bandage 35      A                  2079                                                                               D                          D1A S       198201012003010120021231N                           
A446200100PABDOMINAL DRESSING HOLDER, EACH                                                 Abdmnl drssng holder/binder 35      A                  2079                                                                               D                          D1A S       1998010120030101        N                           
A446400100PJOINT SUPPORTIVE DEVICE/GARMENT, ELASTIC OR EQUAL, EACH                         Joint support device/garment00      9                  2303                                                                               M                          Z2  P       200101012003010120021231N                           
A446500100PNON-ELASTIC BINDER FOR EXTREMITY                                                Non-elastic extremity binder00      9                                                                                                     C                          D1A 9       1994010119950101        N                           
A447000100PGRAVLEE JET WASHER                                                              Gravlee jet washer          00      950-4              2320                                                                               D                          D1A P       1986010120010101        N                           
A448000100PVABRA ASPIRATOR                                                                 Vabra aspirator             00      950-10             2320                                                                               D                          D1A P       1986010120010101        N                           
A448100100PTRACHEOSTOMA FILTER, ANY TYPE, ANY SIZE, EACH                                   Tracheostoma filter         37      A                  2130                                                                               D                          D1F P       1997010120030101        N                           
A448300100PMOISTURE EXCHANGER, DISPOSABLE, FOR USE WITH INVASIVE MECHANICAL VENTILATION    Moisture exchanger          37      A                  2130                                                                               D                          D1F P       1999010120030101        N                           
A449000100PSURGICAL STOCKINGS ABOVE KNEE LENGTH, EACH                                      Above knee surgical stocking00      960-9              2079    2100                                                                       M                          D1A P       1986010120030101        N                           
A449500100PSURGICAL STOCKINGS THIGH LENGTH, EACH                                           Thigh length surg stocking  00      960-9              2079    2100                                                                       M                          D1A P       1986010120030101        N                           
A450000100PSURGICAL STOCKINGS BELOW KNEE LENGTH, EACH                                      Below knee surgical stocking00      960-9              2079    2100                                                                       M                          D1A P       1986010120030101        N                           
A451000100PSURGICAL STOCKINGS FULL LENGTH, EACH                                            Full length surg stocking   00      960-9              2079    2100                                                                       M                          D1A P       1986010120030101        N                           
A452000100PINCONTINENCE GARMENT, ANY TYPE, (E.G. BRIEF, DIAPER), EACH                      Incontinence garment anytype00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
A452100100PADULT-SIZED INCONTINENCE PRODUCT, DIAPER, SMALL SIZE, EACH                      Adult size diaper sm each   00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A452200100PADULT-SIZED INCONTINENCE PRODUCT, DIAPER, MEDIUM SIZE, EACH                     Adult size diaper med each  00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A452300100PADULT-SIZED INCONTINENCE PRODUCT, DIAPER, LARGE SIZE, EACH                      Adult size diaper lg each   00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A452400100PADULT-SIZED INCONTINENCE PRODUCT, DIAPER, EXTRA LARGE SIZE, EACH                Adult size diaper xl each   00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A452500100PADULT-SIZED INCONTINENCE PRODUCT, BRIEF, SMALL SIZE, EACH                       Adult size brief sm each    00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A452600100PADULT-SIZED INCONTINENCE PRODUCT, BRIEF, MEDIUM SIZE, EACH                      Adult size brief med each   00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A452700100PADULT-SIZED INCONTINENCE PRODUCT, BRIEF, LARGE SIZE, EACH                       Adult size brief lg each    00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A452800100PADULT-SIZED INCONTINENCE PRODUCT, BRIEF, EXTRA-LARGE SIZE, EACH                 Adult size brief xl each    00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A452900100PCHILD-SIZED INCONTINENCE PRODUCT, DIAPER, SMALL/MEDIUM SIZE, EACH               Child size diaper sm/med ea 00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A453000100PCHILD-SIZED INCONTINENCE PRODUCT, DIAPER, LARGE SIZE, EACH                      Child size diaper lg each   00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A453100100PCHILD-SIZED INCONTINENCE PRODUCT, BRIEF, SMALL/MEDIUM SIZE, EACH                Child size brief sm/med each00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A453200100PCHILD-SIZED INCONTINENCE PRODUCT, BRIEF, LARGE SIZE, EACH                       Child size brief lg each    00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A453300100PYOUTH-SIZED INCONTINENCE PRODUCT, DIAPER, EACH                                  Youth size diaper each      00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A453400100PYOUTH-SIZED INCONTINENCE PRODUCT, BRIEF, EACH                                   Youth size brief each       00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A453500100PDISPOSABLE LINER/SHIELD FOR INCONTINENCE, EACH                                  Disp incont liner/shield ea 00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A453600100PPROTECTIVE UNDERWEAR, WASHABLE, ANY SIZE, EACH                                  Prot underwr wshbl any sz ea00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A453700100PUNDER PAD, REUSABLE/WASHABLE, ANY SIZE, EACH                                    Under pad reusable any sz ea00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A453800100PDIAPER, REUSABLE, PROVIDED BY A DIAPER SERVICE, EACH DIAPER                     Reusable diaper from dpr svc00      960-9                                                                                                 M                          D1A 9       200301012005010120041231N                           
A455000100PSURGICAL TRAYS                                                                  Surgical trays              11      A                  15030                                                                              D                          Y1  9       1982010120000101        N                           
A455400100PDISPOSABLE UNDERPADS, ALL SIZES                                                 Disposable underpads        00      960-9                                                                                                 M                          D1A 9       1986010120050101        F                           
A455600100PELECTRODES, (E.G., APNEA MONITOR), PER PAIR                                     Electrodes, pair            34      A                                                                                                     C                          D1E P       1984010120000101        N                           
A455700100PLEAD WIRES, (E.G., APNEA MONITOR), PER PAIR                                     Lead wires, pair            34      A                                                                                                     C                          D1E P       1984010120000101        N                           
A455800100PCONDUCTIVE PASTE OR GEL                                                         Conductive paste or gel     34      A                                                                                                     C                          D1E P       1985010119960101        N                           
A456100100PPESSARY, RUBBER, ANY TYPE                                                       Pessary rubber, any type    38      A                                                                                                     C                          D1F P       2001010120010101        N                           
A456200100PPESSARY, NON RUBBER, ANY TYPE                                                   Pessary, non rubber,any type38      A                                                                                                     C                          D1F P       2001010120010101        N                           
A456500100PSLINGS                                                                          Slings                      52      A                                                                                                     C                          D1A P       1983010119960101        N                           
A457000100PSPLINT                                                                          Splint                      52      A                  2079                                                                               I                          D1A P       1982010120010701        N                           
A457200100PRIB BELT                                                                        Rib belt                    52      A                                                                            L0210                    C                          D1A P       198201012003010120021231N                           
A457500100PTOPICAL HYPERBARIC OXYGEN CHAMBER, DISPOSABLE                                   Hyperbaric o2 chamber disps 00      935-10                                                                                                M                          D1A 9       1996010119960101        N                           
A458000100PCAST SUPPLIES (E.G. PLASTER)                                                    Cast supplies (plaster)     00      9                  2079                                                                               I                          D1A 9       1982010120030101        N                           
A459000100PSPECIAL CASTING MATERIAL (E.G. FIBERGLASS)                                      Special casting material    00      9                  2079                                                                               I                          D1A 9       1984010120030101        N                           
A459500100PELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G. TENS, NMES)            TENS suppl 2 lead per month 34      A45-25                                                                                                D                          D1E P       1996010120030101        N                           
A460400100PTUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE    Tubing with heating element 32      A                                                                                                     C                          D1E P       2006010120060101        A                           
A460400200QDEVICE                                                                                                                                                                                                                                                                                                               
A460500100PTRACHEAL SUCTION CATHETER, CLOSED SYSTEM, EACH                                  Trach suction cath close sys32      A                                                                                                     C                          D1E P       2005010120050101        N                           
A460600100POXYGEN PROBE FOR USE WITH OXIMETER DEVICE, REPLACEMENT                          Oxygen probe used w oximeter00      9                                                                                                     C                          D1E 9       2003010120030101        N                           
A460800100PTRANSTRACHEAL OXYGEN CATHETER, EACH                                             Transtracheal oxygen cath   32      A                                                                                                     C                          D1E P       2001010120010101        N                           
A460900100PTRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR LESS THAN 72 HOURS OF USE, EACH   Trach suction cath clsed sys32      A                                                                            A4605                    C                          D1E P       200301012005010120041231N                           
A461000100PTRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR 72 OR MORE HOURS OF USE, EACH     Trach sctn cath 72h clsedsys32      A                                                                            A4605                    C                          D1E P       200301012006010120041231N                           
A461100100PBATTERY, HEAVY DUTY; REPLACEMENT FOR PATIENT OWNED VENTILATOR                   Heavy duty battery          32      A                                                                                                     C                          D1E P       1990010119960101        N                           
A461200100PBATTERY CABLES; REPLACEMENT FOR PATIENT-OWNED VENTILATOR                        Battery cables              32      A                                                                                                     C                          D1E P       1990010119960101        N                           
A461300100PBATTERY CHARGER; REPLACEMENT FOR PATIENT-OWNED VENTILATOR                       Battery charger             32      A                                                                                                     C                          D1E P       1990010119960101        N                           
A461400100PPEAK EXPIRATORY FLOW RATE METER, HAND HELD                                      Hand-held PEFR meter        46      A                                                                                                     C                          Z2  9       1999010119990101        N                           
A461500100PCANNULA, NASAL                                                                  Cannula nasal               33      A60-4              3312                                                                               D                          D1C P       1990010119960101        N                           
A461600100PTUBING (OXYGEN), PER FOOT                                                       Tubing (oxygen) per foot    33      A60-4              3312                                                                               D                          D1C P       1990010119960101        N                           
A461700100PMOUTH PIECE                                                                     Mouth piece                 33      A60-4              3312                                                                               D                          D1C P       1990010119960101        N                           
A461800100PBREATHING CIRCUITS                                                              Breathing circuits          32      A60-4              3312                                                                               D                          D1E APR     1990010119930101        N                           
A461900100PFACE TENT                                                                       Face tent                   33      A60-4              3312                                                                               D                          D1C P       1990010119960101        N                           
A462000100PVARIABLE CONCENTRATION MASK                                                     Variable concentration mask 33      A60-4              3312                                                                               D                          D1C P       1990010119960101        N                           
A462100100PTRACHEOTOMY MASK OR COLLAR                                                      Tracheotomy mask or collar  33      A                  2130                                                                               D                          D1C P       199001012004010120031231N                           
A462200100PTRACHEOSTOMY OR LARYNGECTOMY TUBE                                               Tracheostomy or larngectomy 37      A65-16             2130                                                                               D                          D1F P       199001012004010120031231N                           
A462300100PTRACHEOSTOMY, INNER CANNULA                                                     Tracheostomy inner cannula  37      A65-16             2130                                                                               D                          D1F P       1990010120040101        N                           
A462400100PTRACHEAL SUCTION CATHETER, ANY TYPE OTHER THAN CLOSED SYSTEM, EACH              Tracheal suction tube       32      A                                                                                                     C                          D1E P       1990010120030101        N                           
A462500100PTRACHEOSTOMY CARE KIT FOR NEW TRACHEOSTOMY                                      Trach care kit for new trach37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A462600100PTRACHEOSTOMY CLEANING BRUSH, EACH                                               Tracheostomy cleaning brush 37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A462700100PSPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR USE WITH METERED DOSE       Spacer bag/reservoir        00      9                  2100                                                                               M                          D1A 9       1991010119970101        N                           
A462700200QINHALER                                                                                                                                                                                                                                                                                                              
A462800100POROPHARYNGEAL SUCTION CATHETER, EACH                                            Oropharyngeal suction cath  32      A                                                                                                     C                          D1E APR     1996010119960101        N                           
A462900100PTRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACHEOSTOMY                              Tracheostomy care kit       37      A                  2130                                                                               D                          D1F P       1996010120030101        N                           
A463000100PREPLACEMENT BATTERIES,  MEDICALLY NECESSARY, TRANSCUTANEOUS ELECTRICAL          Repl bat t.e.n.s. own by pt 32      A65-8                                                                                                 D                          D1E APR     1991010120060101        C                           
A463000200QSTIMULATOR, OWNED BY PATIENT                                                                                                                                                                                                                                                                                         
A463100100PREPLACEMENT, BATTERIES FOR MEDICALLY NECESSARY ELECTRONIC WHEEL CHAIR OWNED BY  Wheelchair battery          32      A60-9                                                                                                 D                          D1E APR     199101012004010120031231N                           
A463100200QPATIENT                                                                                                                                                                                                                                                                                                              
A463200100PREPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP, ANY TYPE, EACH                  Infus pump rplcemnt battery 00      9                                                                                                     I                          D1E APR     2003010120060101        F                           
A463300100PREPLACEMENT BULB/LAMP FOR ULTRAVIOLET LIGHT THERAPY SYSTEM, EACH                Uvl replacement bulb        32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A463400100PREPLACEMENT BULB FOR THERAPEUTIC LIGHT BOX, TABLETOP MODEL                      Replacement bulb th lightbox00      9                                                                                                     C                          D1E 9       2003010120030101        N                           
A463500100PUNDERARM  PAD, CRUTCH, REPLACEMENT, EACH                                        Underarm crutch pad         32      A60-9                                                                                                 D                          D1E APR     1991010119960101        N                           
A463600100PREPLACEMENT, HANDGRIP, CANE, CRUTCH, OR WALKER, EACH                            Handgrip for cane etc       32      A60-9                                                                                                 D                          D1E APR     1991010119960101        N                           
A463700100PREPLACEMENT, TIP, CANE, CRUTCH, WALKER, EACH.                                   Repl tip cane/crutch/walker 32      A60-9                                                                                                 D                          D1E APR     1991010119960101        N                           
A463800100PREPLACEMENT BATTERY FOR PATIENT-OWNED EAR PULSE GENERATOR, EACH                 Repl batt pulse gen sys     32      A                                                                                                     C                          D1E P       2004010120040101        N                           
A463900100PREPLACEMENT PAD FOR INFRARED HEATING PAD SYSTEM, EACH                           Infrared ht sys replcmnt pad32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A464000100PREPLACEMENT PAD  FOR USE WITH MEDICALLY NECESSARY ALTERNATING PRESSURE PAD      Alternating pressure pad    32      A60-9              4107.6                                                                             D                          D1E APR     1991010119960101        N                           
A464000200QOWNED BY PATIENT                                                                                                                                                                                                                                                                                                     
A464100100PRADIOPHARMACEUTICAL, DIAGNOSTIC, NOT OTHERWISE CLASSIFIED                       Radiopharm dx agent noc     51      A                                                                                                     C                          I1E 4       1994010120060101        B                           
A464200100PINDIUM IN-111 SATUMOMAB PENDETIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 6          In111 satumomab             51      A                                                                                                     C                          I1E 4       1995010120060101        B                           
A464200200QMILLICURIES                                                                                                                                                                                                                                                                                                          
A464300100PSUPPLY OF ADDITIONAL HIGH DOSE CONTRAST MATERIAL(S) DURING MAGNETIC RESONANCE   High dose contrast MRI      00      9                                                                                                     I                          I2D 4       199501012006010120051231D                           
A464300200QIMAGING, E.G., GADOTERIDOL INJECTION                                                                                                                                                                                                                                                                                 
A464400100PSUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (100-199 MGS OF IODINE)                 Contrast 100-199 MGs iodine 00      9                                                                                                     I                          I1E 4       199401012006010120051231D                           
A464500100PSUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (200-299 MGS OF IODINE)                 Contrast 200-299 MGs iodine 00      9                                                                                                     I                          I1F 4       199401012006010120051231D                           
A464600100PSUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (300-399 MGS OF IODINE)                 Contrast 300-399 MGs iodine 00      9                                                                                                     I                          I1F 4       199401012006010120051231D                           
A464700100PSUPPLY OF PARAMAGNETIC CONTRAST MATERIAL, EG., GADOLINIUM                       Supp- paramagnetic contr mat00      9                                                                                                     I                          I1F 4       199001012006010120051231D                           
A464900100PSURGICAL SUPPLY; MISCELLANEOUS                                                  Surgical supplies           46      A                                                                                                     C                          D1A 9       1982010119980101        N                           
A465100100PCALIBRATED MICROCAPILLARY TUBE, EACH                                            Calibrated microcap tube    52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A465200100PMICROCAPILLARY TUBE SEALANT                                                     Microcapillary tube sealant 52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A465300100PPERITONEAL DIALYSIS CATHETER ANCHORING DEVICE, BELT, EACH                       PD catheter anchor belt     52      A                                                                                                     C                          P9B L       2003010120030101        N                           
A465600100PNEEDLE, ANY SIZE, EACH                                                          Needle any size             52      A                  4270                                                                               D                      0017P9B L       200201012006010120051231D                           
A465700100PSYRINGE, WITH OR WITHOUT NEEDLE, EACH                                           Syringe w/wo needle         52      A                  4270                                                                               D                      0017P9B L       2002010120030101        N                           
A466000100PSPHYGMOMANOMETER/BLOOD PRESSURE APPARATUS WITH CUFF AND STETHOSCOPE             Sphyg/bp app w cuff and stet52      A                  4270                                                                               D                      0017P9B L       1986010120030101        N                           
A466300100PBLOOD PRESSURE CUFF ONLY                                                        Dialysis blood pressure cuff52      A                  4270                                                                               D                      0017P9B L       1986010120030101        N                           
A467000100PAUTOMATIC BLOOD PRESSURE MONITOR                                                Automatic bp monitor, dial  00      950-42             4270                                                                               M                      0017P9B L       1986010120030101        N                           
A467100100PDISPOSABLE CYCLER SET USED WITH CYCLER DIALYSIS MACHINE, EACH                   Disposable cycler set       52      A                  4270                                                                               D                          P9B L       2004010120040101        N                           
A467200100PDRAINAGE EXTENSION LINE, STERILE, FOR DIALYSIS, EACH                            Drainage ext line, dialysis 52      A                  4270                                                                               D                          P9B L       2004010120040101        N                           
A467300100PEXTENSION LINE WITH EASY LOCK CONNECTORS, USED WITH DIALYSIS                    Ext line w easy lock connect52      A                  4270                                                                               D                          P9B L       2004010120040101        N                           
A467400100PCHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERILIZE DIALYSIS EQUIPMENT, PER  Chem/antisept solution, 8oz 52      A                  4270                                                                               D                          P9B L       2004010120040101        N                           
A467400200Q8 OZ                                                                                                                                                                                                                                                                                                                 
A468000100PACTIVATED CARBON FILTER FOR HEMODIALYSIS, EACH                                  Activated carbon filter, ea 52      A55-1              4270                                                                               D                      0017P9B L       1986010120020101        N                           
A469000100PDIALYZER (ARTIFICIAL KIDNEYS), ALL TYPES, ALL SIZES, FOR HEMODIALYSIS, EACH     Dialyzer, each              52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A470600100PBICARBONATE CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON                 Bicarbonate conc sol per gal52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A470700100PBICARBONATE CONCENTRATE, POWDER, FOR HEMODIALYSIS, PER PACKET                   Bicarbonate conc pow per pac52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A470800100PACETATE CONCENTRATE SOLUTION, FOR HEMODIALYSIS, PER GALLON                      Acetate conc sol per gallon 52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A470900100PACID CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON                        Acid conc sol per gallon    52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A471200100PWATER, STERILE, FOR INJECTION, PER 10 ML                                        Sterile water inj per 10 ml 52      A                  4270                                                                               D                      0017P9B L       198601012004010120031231N                           
A471400100PTREATED WATER (DEIONIZED, DISTILLED, OR REVERSE OSMOSIS) FOR PERITONEAL         Treated water per gallon    52      A55-1              4270                                                                               D                      0017P9B L       1986010120020101        N                           
A471400200QDIALYSIS, PER GALLON                                                                                                                                                                                                                                                                                                 
A471900100P"Y SET" TUBING FOR PERITONEAL DIALYSIS                                          "Y set" tubing              52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A472000100PDIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialysat sol fld vol > 249cc52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A472000200Q249CC, BUT LESS THAN OR EQUAL TO 999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                      
A472100100PDIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialysat sol fld vol > 999cc52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A472100200Q999CC BUT LESS THAN OR EQUAL TO 1999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                      
A472200100PDIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 1999cc 52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A472200200Q1999CC BUT LESS THAN OR EQUAL TO 2999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                     
A472300100PDIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 2999cc 52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A472300200Q2999CC BUT LESS THAN OR EQUAL TO 3999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                     
A472400100PDIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 3999cc 52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A472400200Q3999CC BUT LESS THAN OR EQUAL TO 4999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                     
A472500100PDIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 4999cc 52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A472500200Q4999CC BUT LESS THAN OR EQUAL TO 5999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                     
A472600100PDIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 5999cc 52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A472600200Q5999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                                                      
A472800100PDIALYSATE SOLUTION, NON-DEXTROSE CONTAINING, 500 ML                             Dialysate solution, non-dex 52      A                                                                                                     C                          P9B L       2004010120040101        N                           
A473000100PFISTULA CANNULATION SET FOR HEMODIALYSIS, EACH                                  Fistula cannulation set, ea 52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A473600100PTOPICAL ANESTHETIC, FOR DIALYSIS, PER GRAM                                      Topical anesthetic, per gram52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A473700100PINJECTABLE ANESTHETIC, FOR DIALYSIS, PER 10 ML                                  Inj anesthetic per 10 ml    52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A474000100PSHUNT ACCESSORY, FOR HEMODIALYSIS, ANY TYPE, EACH                               Shunt accessory             52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A475000100PBLOOD TUBING, ARTERIAL OR VENOUS, FOR HEMODIALYSIS, EACH                        Art or venous blood tubing  52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A475500100PBLOOD TUBING, ARTERIAL AND VENOUS COMBINED, FOR HEMODIALYSIS, EACH              Comb art/venous blood tubing52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A476000100PDIALYSATE SOLUTION TEST KIT, FOR PERITONEAL DIALYSIS, ANY TYPE, EACH            Dialysate sol test kit, each52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A476500100PDIALYSATE CONCENTRATE, POWDER, ADDITIVE FOR PERITONEAL DIALYSIS, PER PACKET     Dialysate conc pow per pack 52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A476600100PDIALYSATE CONCENTRATE, SOLUTION, ADDITIVE FOR PERITONEAL DIALYSIS, PER 10 ML    Dialysate conc sol add 10 ml52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A477000100PBLOOD COLLECTION TUBE, VACUUM, FOR DIALYSIS, PER 50                             Blood collection tube/vacuum52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A477100100PSERUM CLOTTING TIME TUBE, FOR DIALYSIS, PER 50                                  Serum clotting time tube    52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A477200100PBLOOD GLUCOSE TEST STRIPS, FOR DIALYSIS, PER 50                                 Blood glucose test strips   52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A477300100POCCULT BLOOD TEST STRIPS, FOR DIALYSIS, PER 50                                  Occult blood test strips    52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A477400100PAMMONIA TEST STRIPS, FOR DIALYSIS, PER 50                                       Ammonia test strips         52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A480100100PHEPARIN, ANY TYPE, FOR HEMODIALYSIS, PER 1000 UNITS                             Heparin per 1000 units      52      A                  4270                                                      J1644                    D                      0017P9B L       200201012003010120021231N                           
A480200100PPROTAMINE SULFATE, FOR HEMODIALYSIS, PER 50 MG                                  Protamine sulfate per 50 mg 52      A                  4270                                                                               D                      0017P9B L       2002010120020101        N                           
A486000100PDISPOSABLE CATHETER TIPS FOR PERITONEAL DIALYSIS, PER 10                        Disposable catheter tips    52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A487000100PPLUMBING AND/OR ELECTRICAL WORK FOR HOME HEMODIALYSIS EQUIPMENT                 Plumb/elec wk hm hemo equip 52      A                  4270                                                                               D                      0017P9B L       1986010120020101        N                           
A489000100PCONTRACTS, REPAIR AND MAINTENANCE, FOR HEMODIALYSIS EQUIPMENT                   Repair/maint cont hemo equip52      A                  2100.4                                                                             D                      0017P9B L       1986010120020101        N                           
A491100100PDRAIN BAG/BOTTLE, FOR DIALYSIS, EACH                                            Drain bag/bottle            52      A                                                                                                     D                      0017P9B L       2002010120020101        N                           
A491300100PMISCELLANEOUS DIALYSIS SUPPLIES, NOT OTHERWISE SPECIFIED                        Misc dialysis supplies noc  52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
A491800100PVENOUS PRESSURE CLAMP, FOR HEMODIALYSIS, EACH                                   Venous pressure clamp       52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
A492700100PGLOVES, NON-STERILE, PER 100                                                    Non-sterile gloves          52      A                                                                                                     D                      0017P9B L       1986010120030101        N                           
A492800100PSURGICAL MASK, PER 20                                                           Surgical mask               52      A                                                                                                     D                      0017P9B L       2002010120030101        N                           
A492900100PTOURNIQUET FOR DIALYSIS, EACH                                                   Tourniquet for dialysis, ea 52      A                                                                                                     D                      0017P9B L       2002010120020101        N                           
A493000100PGLOVES, STERILE, PER PAIR                                                       Sterile, gloves per pair    52      A                                                                                                     D                      0017P9B L       2003010120030101        N                           
A493100100PORAL THERMOMETER, REUSABLE, ANY TYPE, EACH                                      Reusable oral thermometer   52      A                                                                                                     C                          P9B L       2003010120030101        N                           
A493200100PRECTAL THERMOMETER, REUSABLE, ANY TYPE, EACH                                    Reusable rectal thermometer 00      9                                                                                                     I                          Z2  9       2003010120060101        F                           
A505100100POSTOMY POUCH, CLOSED; WITH BARRIER ATTACHED (1 PIECE), EACH                     Pouch clsd w barr attached  37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A505200100POSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED (1 PIECE), EACH                  Clsd ostomy pouch w/o barr  37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A505300100POSTOMY POUCH, CLOSED; FOR USE ON FACEPLATE, EACH                                Clsd ostomy pouch faceplate 37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A505400100POSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH            Clsd ostomy pouch w/flange  37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A505500100PSTOMA CAP                                                                       Stoma cap                   37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A506100100POSTOMY POUCH, DRAINABLE; WITH BARRIER ATTACHED, (1 PIECE), EACH                 Pouch drainable w barrier at37      A                                                                                                     C                          D1F P       1990010120030101        N                           
A506200100POSTOMY POUCH, DRAINABLE; WITHOUT BARRIER ATTACHED (1 PIECE), EACH               Drnble ostomy pouch w/o barr37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A506300100POSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH FLANGE (2 PIECE SYSTEM), EACH  Drain ostomy pouch w/flange 37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A507100100POSTOMY POUCH, URINARY; WITH BARRIER ATTACHED (1 PIECE), EACH                    Urinary pouch w/barrier     37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A507200100POSTOMY POUCH, URINARY; WITHOUT BARRIER ATTACHED (1 PIECE), EACH                 Urinary pouch w/o barrier   37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A507300100POSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH           Urinary pouch on barr w/flng37      A                  2130                                                                               D                          D1F P       1990010120030101        N                           
A508100100PCONTINENT DEVICE; PLUG FOR CONTINENT STOMA                                      Continent stoma plug        37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A508200100PCONTINENT DEVICE; CATHETER FOR CONTINENT STOMA                                  Continent stoma catheter    37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A509300100POSTOMY ACCESSORY; CONVEX INSERT                                                 Ostomy accessory convex inse37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A510200100PBEDSIDE DRAINAGE BOTTLE WITH OR WITHOUT TUBING, RIGID OR EXPANDABLE, EACH       Bedside drain btl w/wo tube 37      A                  2130                                                                               D                          D1F P       1990010119970101        N                           
A510500100PURINARY SUSPENSORY; WITH LEG BAG, WITH OR WITHOUT TUBE                          Urinary suspensory          37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A511200100PURINARY LEG BAG; LATEX                                                          Urinary leg bag             37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A511300100PLEG STRAP; LATEX, REPLACEMENT ONLY, PER SET                                     Latex leg strap             37      A                  2130                                                                               D                          D1F P       1990010119980101        N                           
A511400100PLEG STRAP; FOAM OR FABRIC,  REPLACEMENT ONLY, PER SET                           Foam/fabric leg strap       37      A                  2130                                                                               D                          D1F P       1990010119980101        N                           
A511900100PSKIN BARRIER, WIPES OR SWABS, PER BOX 50                                        Skin barrier wipes box pr 5037      A                  2130                                                                               D                          D1F P       199001012006010120051231D                           
A512000100PSKIN BARRIER, WIPES OR SWABS, EACH                                              Skin barrier, wipe or swab  37      A                  2130                                                                               D                          D1F P       2006010120060101        A                           
A512100100PSKIN BARRIER; SOLID, 6 X 6 OR EQUIVALENT, EACH                                  Solid skin barrier 6x6      37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A512200100PSKIN BARRIER; SOLID, 8 X 8 OR EQUIVALENT, EACH                                  Solid skin barrier 8x8      37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A512300100PSKIN BARRIER; WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), ANY SIZE, EACH        Skin barrier with flange    37      A                  2130                                                                               D                          D1A P       199001012003010120021231N                           
A512600100PADHESIVE OR NON-ADHESIVE;  DISK OR FOAM PAD                                     Disk/foam pad +or- adhesive 37      A                  2130                                                                               D                          D1F P       1990010120000101        N                           
A513100100PAPPLIANCE CLEANER, INCONTINENCE AND OSTOMY APPLIANCES, PER 16 OZ.               Appliance cleaner           37      A                  2130                                                                               D                          D1F P       1990010119900101        N                           
A520000100PPERCUTANEOUS CATHETER/TUBE ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT           Percutaneous catheter anchor37      A                  2130                                                                               D                          D1F P       1999010120030101        N                           
A550000100PFOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND       Diab shoe for density insert38      A                  2134                                                                               D                          D1F J       1995010120050101        N                           
A550000200QSUPPLY OF OFF-THE-SHELF DEPTH-INLAY SHOE MANUFACTURED TO ACCOMMODATE MULTI-                                                                                                                                                                                                                                          
A550000300QDENSITY INSERT(S), PER SHOE.                                                                                                                                                                                                                                                                                         
A550100100PFOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND       Diabetic custom molded shoe 38      A                  2134                                                                               D                          D1F J       1995010120050101        N                           
A550100200QSUPPLY OF SHOE MOLDED FROM CAST(S) OF PATIENT'S FOOT (CUSTOM MOLDED SHOE), PER                                                                                                                                                                                                                                       
A550100300QSHOE                                                                                                                                                                                                                                                                                                                 
A550300100PFOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF           Diabetic shoe w/roller/rockr38      A                  2134                                                                               D                          D1F J       1995010120050101        N                           
A550300200QDEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH ROLLER OR RIGID ROCKER BOTTOM, PER                                                                                                                                                                                                                                       
A550300300QSHOE                                                                                                                                                                                                                                                                                                                 
A550400100PFOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF           Diabetic shoe with wedge    38      A                  2134                                                                               D                          D1F J       1995010120050101        N                           
A550400200QDEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH WEDGE(S), PER SHOE                                                                                                                                                                                                                                                       
A550500100PFOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF           Diab shoe w/metatarsal bar  38      A                  2134                                                                               D                          D1F J       1995010120050101        N                           
A550500200QDEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH METATARSAL BAR, PER SHOE                                                                                                                                                                                                                                                 
A550600100PFOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF           Diabetic shoe w/off set heel38      A                  2134                                                                               D                          D1F J       1995010120050101        N                           
A550600200QDEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH OFF-SET HEEL(S), PER SHOE                                                                                                                                                                                                                                                
A550700100PFOR DIABETICS ONLY, NOT OTHERWISE SPECIFIED MODIFICATION (INCLUDING FITTING) OF Modification diabetic shoe  38      A                  2134                                                                               D                          D1F J       1995010120050101        N                           
A550700200QOFF-THE-SHELF DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE, PER SHOE                                                                                                                                                                                                                                                       
A550800100PFOR DIABETICS ONLY, DELUXE FEATURE OF OFF-THE-SHELF DEPTH-INLAY SHOE OR         Diabetic deluxe shoe        38      A                  2134                                                                               D                          D1F J       2000010120050101        N                           
A550800200QCUSTOM-MOLDED SHOE, PER SHOE                                                                                                                                                                                                                                                                                         
A550900100PFOR DIABETICS ONLY, DIRECT FORMED, MOLDED TO FOOT WITH EXTERNAL HEAT SOURCE     Direct heat form shoe insert00      9                  2134                                                                               I                          D1F J       200201012006010120051231D                           
A550900200Q(I.E. HEAT GUN) MULTIPLE DENSITY INSERT (S), PREFABRICATED, PER SHOE                                                                                                                                                                                                                                                 
A551000100PFOR DIABETICS ONLY, DIRECT FORMED, COMPRESSION MOLDED TO PATIENT'S FOOT WITHOUT Compression form shoe insert38      A                  2134                                                                               D                          D1F J       2002010120050101        N                           
A551000200QEXTERNAL HEAT SOURCE, MULTIPLE-DENSITY INSERT(S) PREFABRICATED, PER SHOE                                                                                                                                                                                                                                             
A551100100PFOR DIABETICS ONLY, CUSTOM-MOLDED FROM MODEL OF PATIENT'S FOOT, MULTIPLE        Custom fab molded shoe inser00      9                  2134                                                                               I                          D1F J       200201012006010120051231D                           
A551100200QDENSITY INSERT(S), CUSTOM-FABRICATED, PER SHOE                                                                                                                                                                                                                                                                       
A551200100PFOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT      Multi den insert direct form52      A                                                                                                     C                          D1F J       2006010120060101        A                           
A551200200QAFTER EXTERNAL HEAT SOURCE OF 230 DEGREES FAHRENHEIT OR HIGHER, TOTAL CONTACT                                                                                                                                                                                                                                        
A551200300QWITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER MINIMUM OF 1/4 INCH MATERIAL OF                                                                                                                                                                                                                                      
A551200400QSHORE A 35 DUROMETER OR 3/16 INCH MATERIAL OF SHORE A 40 DUROMETER (OR HIGHER),                                                                                                                                                                                                                                      
A551200500QPREFABRICATED, EACH                                                                                                                                                                                                                                                                                                  
A551300100PFOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, CUSTOM MOLDED FROM MODEL OF        Multi den insert custom mold52      A                                                                                                     C                          D1F J       2006010120060101        A                           
A551300200QPATIENT'S FOOT, TOTAL CONTACT WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER                                                                                                                                                                                                                                        
A551300300QMINIMUM OF 1/4 INCH MATERIAL OF SHORE A 35 DUROMETER OR 3/16 INCH MATERIAL OF                                                                                                                                                                                                                                        
A551300400QSHORE A 40 DUROMETER (OR HIGHER), INCLUDES ARCH FILLER AND OTHER SHAPING                                                                                                                                                                                                                                             
A551300500QMATERIAL, CUSTOM FABRICATED, EACH                                                                                                                                                                                                                                                                                    
A600000100PNON-CONTACT WOUND WARMING WOUND COVER FOR USE WITH THE NON-CONTACT WOUND        Wound warming wound cover   00      9                  2303                                                                               M                          D1E P       2002010120020701        N                           
A600000200QWARMING DEVICE AND WARMING CARD                                                                                                                                                                                                                                                                                      
A601000100PCOLLAGEN BASED WOUND FILLER, DRY FORM, PER GRAM OF COLLAGEN                     Collagen based wound filler 35      A                  2079                                                                               D                          D1A S       2002010120030101        N                           
A601100100PCOLLAGEN BASED WOUND FILLER, GEL/PASTE, PER GRAM OF COLLAGEN                    Collagen gel/paste wound fil35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A602100100PCOLLAGEN DRESSING, PAD SIZE 16 SQ. IN. OR LESS, EACH                            Collagen dressing <=16 sq in35      A                  2079                                                                               D                          D1A S       2001010120030101        N                           
A602200100PCOLLAGEN DRESSING, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48   Collagen drsg>6<=48 sq in   35      A                  2079                                                                               D                          D1A S       2001010120030101        N                           
A602200200QSQ. IN., EACH                                                                                                                                                                                                                                                                                                        
A602300100PCOLLAGEN DRESSING, PAD SIZE MORE THAN 48 SQ. IN., EACH                          Collagen dressing >48 sq in 35      A                  2079                                                                               D                          D1A S       2001010120030101        N                           
A602400100PCOLLAGEN DRESSING WOUND FILLER, PER 6 INCHES                                    Collagen dsg wound filler   35      A                  2079                                                                               D                          D1A S       2001010120030101        N                           
A602500100PGEL SHEET FOR DERMAL OR EPIDERMAL APPLICATION, (E.G., SILICONE, HYDROGEL,       Silicone gel sheet, each    00      9                                                                                                     I                          D1A 9       1997010120060101        F                           
A602500200QOTHER), EACH                                                                                                                                                                                                                                                                                                         
A615400100PWOUND POUCH, EACH                                                               Wound pouch each            35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A619600100PALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR   Alginate dressing <=16 sq in35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A619600200QLESS, EACH DRESSING                                                                                                                                                                                                                                                                                                  
A619700100PALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, PAD SIZE MORE THAN 16    Alginate drsg >16 <=48 sq in35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A619700200QSQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING                                                                                                                                                                                                                                                          
A619800100PALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, PAD SIZE MORE THAN 48    alginate dressing > 48 sq in46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A619800200QSQ. IN., EACH DRESSING                                                                                                                                                                                                                                                                                               
A619900100PALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, PER 6 INCHES            Alginate drsg wound filler  35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A620000100PCOMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH  Compos drsg <=16 no border  35      A                  2079                                                                               D                          D1A S       1999010120030101        N                           
A620000200QDRESSING                                                                                                                                                                                                                                                                                                             
A620100100PCOMPOSITE DRESSING, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48  Compos drsg >16<=48 no bdr  35      A                  2079                                                                               D                          D1A S       1999010120030101        N                           
A620100200QSQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                      
A620200100PCOMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER,     Compos drsg >48 no border   46      A                  2079                                                                               D                          D1A S       1999010120030101        N                           
A620200200QEACH DRESSING                                                                                                                                                                                                                                                                                                        
A620300100PCOMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, Composite drsg <= 16 sq in  35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A620300200QEACH DRESSING                                                                                                                                                                                                                                                                                                        
A620400100PCOMPOSITE DRESSING, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48  Composite drsg >16<=48 sq in35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A620400200QSQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                
A620500100PCOMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE       Composite drsg > 48 sq in   46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A620500200QBORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A620600100PCONTACT LAYER, 16 SQ. IN. OR LESS, EACH DRESSING                                Contact layer <= 16 sq in   46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A620700100PCONTACT LAYER, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH  Contact layer >16<= 48 sq in35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A620700200QDRESSING                                                                                                                                                                                                                                                                                                             
A620800100PCONTACT LAYER, MORE THAN 48 SQ. IN., EACH DRESSING                              Contact layer > 48 sq in    46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A620900100PFOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE       Foam drsg <=16 sq in w/o bdr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A620900200QBORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A621000100PFOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR      Foam drg >16<=48 sq in w/o b35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A621000200QEQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                          
A621100100PFOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE     Foam drg > 48 sq in w/o brdr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A621100200QBORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A621200100PFOAM DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE Foam drg <=16 sq in w/border35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A621200200QBORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A621300100PFOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR      Foam drg >16<=48 sq in w/bdr46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A621300200QEQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                    
A621400100PFOAM DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE        Foam drg > 48 sq in w/border35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A621400200QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A621500100PFOAM DRESSING, WOUND FILLER, PER GRAM                                           Foam dressing wound filler  46      A                  2079                                                                               D                          D1A LS      1997010120060101        T                           
A621600100PGAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT       Non-sterile gauze<=16 sq in 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A621600200QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A621700100PGAUZE, 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       1997010120030101        N                           
A621700200QTHAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                  
A621800100PGAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT     Non-sterile gauze > 48 sq in46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A621800200QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A621900100PGAUZE, NON-IMPREGNATED, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE     Gauze <= 16 sq in w/border  35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A621900200QBORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A622000100PGAUZE, NON-IMPREGNATED, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO Gauze >16 <=48 sq in w/bordr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A622000200Q48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                             
A622100100PGAUZE, NON-IMPREGNATED, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE   Gauze > 48 sq in w/border   46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A622100200QBORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A622200100PGAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, PAD SIZE  Gauze <=16 in no w/sal w/o b35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A622200200Q16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                           
A622300100PGAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, PAD SIZE  Gauze >16<=48 no w/sal w/o b35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A622300200QMORE THAN 16 SQUARE INCHES, BUT LESS THAN OR EQUAL TO 48 SQUARE INCHES, WITHOUT                                                                                                                                                                                                                                      
A622300300QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A622400100PGAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, PAD SIZE  Gauze > 48 in no w/sal w/o b35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A622400200QMORE THAN 48 SQUARE INCHES, WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                   
A622800100PGAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SIZE 16 SQ. IN. OR LESS,        Gauze <= 16 sq in water/sal 46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A622800200QWITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                               
A622900100PGAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SIZE MORE THAT 16 SQ. IN. BUT   Gauze >16<=48 sq in watr/sal35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A622900200QLESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                             
A623000100PGAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SIZE MORE THAN 48 SQ. IN.,      Gauze > 48 sq in water/salne46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A623000200QWITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                               
A623100100PGAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, PAD SIZE 16 SQ. IN. OR  Hydrogel dsg<=16 sq in      35      A                  2079                                                                               D                          D1A S       2001010120030101        N                           
A623100200QLESS, EACH DRESSING                                                                                                                                                                                                                                                                                                  
A623200100PGAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, PAD SIZE GREATER THAN   Hydrogel dsg>16<=48 sq in   35      A                  2079                                                                               D                          D1A S       2001010120030101        N                           
A623200200Q16 SQ. IN., BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING                                                                                                                                                                                                                                                      
A623300100PGAUZE, IMPREGNATED, HYDROGEL FOR DIRECT WOUND CONTACT, PAD SIZE MORE THAN 48    Hydrogel dressing >48 sq in 35      A                  2079                                                                               D                          D1A S       2001010120030101        N                           
A623300200QSQ. IN., EACH DRESSING                                                                                                                                                                                                                                                                                               
A623400100PHYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT        Hydrocolld drg <=16 w/o bdr 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A623400200QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A623500100PHYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN Hydrocolld drg >16<=48 w/o b35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A623500200QOR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                       
A623600100PHYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT      Hydrocolld drg > 48 in w/o b35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A623600200QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A623700100PHYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE  Hydrocolld drg <=16 in w/bdr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A623700200QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A623800100PHYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN Hydrocolld drg >16<=48 w/bdr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A623800200QOR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                 
A623900100PHYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY     Hydrocolld drg > 48 in w/bdr46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A623900200QSIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                  
A624000100PHYDROCOLLOID DRESSING, WOUND FILLER, PASTE, PER FLUID OUNCE                     Hydrocolld drg filler paste 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A624100100PHYDROCOLLOID DRESSING, WOUND FILLER, DRY FORM, PER GRAM                         Hydrocolloid drg filler dry 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A624200100PHYDROGEL DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE   Hydrogel drg <=16 in w/o bdr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A624200200QBORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A624300100PHYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR  Hydrogel drg >16<=48 w/o bdr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A624300200QEQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                          
A624400100PHYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE Hydrogel drg >48 in w/o bdr 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A624400200QBORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A624500100PHYDROGEL DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE      Hydrogel drg <= 16 in w/bdr 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A624500200QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A624600100PHYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR  Hydrogel drg >16<=48 in w/b 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A624600200QEQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                    
A624700100PHYDROGEL DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE    Hydrogel drg > 48 sq in w/b 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A624700200QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A624800100PHYDROGEL DRESSING, WOUND FILLER, GEL, PER FLUID OUNCE                           Hydrogel drsg gel filler    35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A625000100PSKIN SEALANTS, PROTECTANTS, MOISTURIZERS, OINTMENTS, ANY TYPE, ANY SIZE         Skin seal protect moisturizr00      9                  2079                                                                               D                          D1A LS      1997010120030101        N                           
A625100100PSPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS,        Absorpt drg <=16 sq in w/o b35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A625100200QWITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                               
A625200100PSPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT   Absorpt drg >16 <=48 w/o bdr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A625200200QLESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                             
A625300100PSPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN.,      Absorpt drg > 48 sq in w/o b35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A625300200QWITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                               
A625400100PSPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH   Absorpt drg <=16 sq in w/bdr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A625400200QANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                              
A625500100PSPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT   Absorpt drg >16<=48 in w/bdr35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A625500200QLESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                       
A625600100PSPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH Absorpt drg > 48 sq in w/bdr46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A625600200QANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                              
A625700100PTRANSPARENT FILM, 16 SQ. IN. OR LESS, EACH DRESSING                             Transparent film <= 16 sq in35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A625800100PTRANSPARENT FILM, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN.,    Transparent film >16<=48 in 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A625800200QEACH DRESSING                                                                                                                                                                                                                                                                                                        
A625900100PTRANSPARENT FILM, MORE THAN 48 SQ. IN., EACH DRESSING                           Transparent film > 48 sq in 35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A626000100PWOUND CLEANSERS, ANY TYPE, ANY SIZE                                             Wound cleanser any type/size00      9                  2079                                                                               D                          D1A LS      1997010120030101        N                           
A626100100PWOUND FILLER,  GEL/PASTE, PER FLUID OUNCE, NOT ELSEWHERE CLASSIFIED             Wound filler gel/paste /oz  46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A626200100PWOUND FILLER, DRY FORM, PER GRAM,  NOT ELSEWHERE CLASSIFIED                     Wound filler dry form / gram46      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A626300100PGAUZE, ELASTIC, NON-STERILE, ALL TYPES, PER LINEAR YARD                         Non-sterile elastic gauze/yd35      A                  2079                                                                               D                          D1A S       199701012003010120021231N                           
A626400100PGAUZE, NON-ELASTIC, NON-STERILE, PER LINEAR YARD                                Non-sterile no elastic gauze35      A                  2079                                                                               D                          D1A S       199701012003010120021231N                           
A626500100PTAPE, ALL TYPES, PER 18 SQUARE INCHES                                           Tape per 18 sq inches       35      A                                                                                                     C                          D1A S       199701012003010120021231N                           
A626600100PGAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALINE, OR ZINC PASTE, ANY WIDTH,  Impreg gauze no h20/sal/yard35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A626600200QPER LINEAR YARD                                                                                                                                                                                                                                                                                                      
A640200100PGAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE  Sterile gauze <= 16 sq in   35      A                  2079                                                                               D                          D1A LS      1997010120060101        T                           
A640200200QBORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A640300100PGAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. LESS THAN OR     Sterile gauze>16 <= 48 sq in35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A640300200QEQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                          
A640400100PGAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT         Sterile gauze > 48 sq in    35      A                  2079                                                                               D                          D1A S       1997010120030101        N                           
A640400200QADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A640500100PGAUZE, ELASTIC, STERILE, ALL TYPES, PER LINEAR YARD                             Sterile elastic gauze /yd   35      A                  2079                                                                               D                          D1A S       199701012003010120021231N                           
A640600100PGAUZE, NON-ELASTIC, STERILE, ALL TYPES, PER LINEAR YARD                         Sterile non-elastic gauze/yd35      A                  2079                                                                               D                          D1A S       199701012003010120021231N                           
A640700100PPACKING STRIPS, NON-IMPREGNATED, UP TO 2 INCHES IN WIDTH, PER LINEAR YARD       Packing strips, non-impreg  35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A641000100PEYE PAD, STERILE, EACH                                                          Sterile eye pad             35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A641100100PEYE PAD, NON-STERILE, EACH                                                      Non-sterile eye pad         35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A641200100PEYE PATCH, OCCLUSIVE, EACH                                                      Occlusive eye patch         00      9                                                                                                     I                          Z2  S       2003010120060101        F                           
A642100100PPADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTED, WIDTH GREATER THAN OR      Pad bandage >=3 <5in w /roll35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A642100200QEQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                                
A642100300QUNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A642200100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN Conf bandage ns >=3<5w/roll35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A642200200QOR EQUAL TO 3 INCHES AND LESS THAN 5 INCHES PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                              
A642200300QUNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A642400100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN Conf bandage ns >=5w /roll 35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A642400200QOR EQUAL TO 5 INCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                                       
A642600100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE WIDTH GREATER THAN OR   Conf bandage s >=3<5 w/roll35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A642600200QEQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                                
A642600300QUNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A642800100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR  Conf bandage s >=5 w /roll 35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A642800200QEQUAL TO 5 INCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                                          
A643000100PLIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE LESS THAN    Lt compres bdg >=3<5w /roll35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A643000200Q1.25 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO 3                                                                                                                                                                                                                                            
A643000300QINCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                              
A643200100PLIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE LESS THAN    Lt compres bdg >=5w /roll  35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A643200200Q1.25 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO 5                                                                                                                                                                                                                                            
A643200300QINCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                                                     
A643400100PMODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE OF 1.25   Mo compres bdg >=3<5w /roll35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A643400200QTO 1.34 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO 3                                                                                                                                                                                                                                         
A643400300QINCHES OR LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                               
A643600100PHIGH COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE GREATER THAN  Hi compres bdg >=3<5w /roll35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A643600200QOR EQUAL TO 1.35 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR                                                                                                                                                                                                                                           
A643600300QEQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                                
A643600400QUNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A643800100PSELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, LOAD RESISTANCE GREATER  Self-adher bdg >=3<5w /roll35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A643800200QTHAN OR EQUAL TO 0.55 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR                                                                                                                                                                                                                                      
A643800300QEQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                                
A643800400QUNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A644000100PZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN  Zinc paste bdg >=3<5w /roll35      A                                                                                                     C                          D1A S       200301012004010120031231N                           
A644000200QOR EQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 10 YARDS,                                                                                                                                                                                                                                            
A644000300QUNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A644100100PPADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTED, WIDTH GREATER THAN OR      Pad band w>=3 <5/yd       35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A644100200QEQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                            
A644200100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH LESS THAN    Conform band n/s w<3/yd    35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A644200200QTHREE INCHES, PER YARD                                                                                                                                                                                                                                                                                               
A644300100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN Conform band n/s w>=3<5/yd35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A644300200QOR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                         
A644400100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN Conform band n/s w>=5/yd   35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A644400200QOR EQUAL TO 5 INCHES, PER YARD                                                                                                                                                                                                                                                                                       
A644500100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH LESS THAN THREE  Conform band s w <3/yd     35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A644500200QINCHES, PER YARD                                                                                                                                                                                                                                                                                                     
A644600100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR  Conform band s w>=3 <5/yd 35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A644600200QEQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                            
A644700100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR  Conform band s w >=5/yd    35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A644700200QEQUAL TO FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                                       
A644800100PLIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH LESS THAN THREE        Lt compres band <3/yd      35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A644800200QINCHES, PER YARD                                                                                                                                                                                                                                                                                                     
A644900100PLIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL  Lt compres band >=3 <5/yd 35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A644900200QTO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                  
A645000100PLIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL  Lt compres band >=5/yd     35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A645000200QTO FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                                             
A645100100PMODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE OF 1.25   Mod compres band w>=3<5/yd35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A645100200QTO 1.34 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO                                                                                                                                                                                                                                           
A645100300QTHREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                     
A645200100PHIGH COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE GREATER THAN  High compres band w>=3<5yd35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A645200200QOR EQUAL TO 1.35 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR                                                                                                                                                                                                                                           
A645200300QEQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                            
A645300100PSELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH LESS THAN THREE    Self-adher band w <3/yd    35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A645300200QINCHES, PER YARD                                                                                                                                                                                                                                                                                                     
A645400100PSELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR    Self-adher band w>=3 <5/yd35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A645400200QEQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                            
A645500100PSELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR    Self-adher band >=5/yd     35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A645500200QEQUAL TO FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                                       
A645600100PZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN  Zinc paste band w >=3<5/yd35      A                                                                                                     C                          D1A S       2004010120040101        N                           
A645600200QOR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                         
A645700100PTUBULAR DRESSING WITH OR WITHOUT ELASTIC, ANY WIDTH, PER LINEAR YARD            Tubular dressing            35      A                                                                                                     C                          D1A S       2006010120060101        A                           
A650100100PCOMPRESSION BURN GARMENT, BODYSUIT (HEAD TO FOOT), CUSTOM FABRICATED            Compres burngarment bodysuit35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A650200100PCOMPRESSION BURN GARMENT, CHIN STRAP, CUSTOM FABRICATED                         Compres burngarment chinstrp35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A650300100PCOMPRESSION BURN GARMENT, FACIAL HOOD, CUSTOM FABRICATED                        Compres burngarment facehood35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A650400100PCOMPRESSION BURN GARMENT, GLOVE TO WRIST, CUSTOM FABRICATED                     Cmprsburngarment glove-wrist35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A650500100PCOMPRESSION BURN GARMENT, GLOVE TO ELBOW, CUSTOM FABRICATED                     Cmprsburngarment glove-elbow35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A650600100PCOMPRESSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM FABRICATED                    Cmprsburngrmnt glove-axilla 35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A650700100PCOMPRESSION BURN GARMENT, FOOT TO KNEE LENGTH, CUSTOM FABRICATED                Cmprs burngarment foot-knee 35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A650800100PCOMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CUSTOM FABRICATED               Cmprs burngarment foot-thigh35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A650900100PCOMPRESSION BURN GARMENT, UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS (VEST),   Compres burn garment jacket 35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A650900200QCUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
A651000100PCOMPRESSION BURN GARMENT, TRUNK, INCLUDING ARMS DOWN TO LEG OPENINGS (LEOTARD), Compres burn garment leotard35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A651000200QCUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
A651100100PCOMPRESSION BURN GARMENT, LOWER TRUNK INCLUDING LEG OPENINGS (PANTY), CUSTOM    Compres burn garment panty  35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A651100200QFABRICATED                                                                                                                                                                                                                                                                                                           
A651200100PCOMPRESSION BURN GARMENT, NOT OTHERWISE CLASSIFIED                              Compres burn garment, noc   35      A                  2079                                                                               D                          D1A S       2003010120030101        N                           
A651300100PCOMPRESSION BURN MASK, FACE AND/OR NECK, PLASTIC OR EQUAL, CUSTOM FABRICATED    Compress burn mask face/neck00      9                                                                                                     C                          D1A P       2006010120060101        A                           
A653000100PGRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH                     Compression stocking BK18-3000      960-9                                                                                                 M                      0072D1F P       2006010120060101        A                           
A653100100PGRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH                     Compression stocking BK30-4035      A                  2079                                                                               D                      0072D1A PS      2006010120060101        A                           
A653200100PGRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH                     Compression stocking BK40-5035      A                  2079                                                                               D                      0072D1A PS      2006010120060101        A                           
A653300100PGRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH                   Gc stocking thighlngth 18-3000      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A653400100PGRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH                   Gc stocking thighlngth 30-4000      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A653500100PGRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH                   Gc stocking thighlngth 40-5000      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A653600100PGRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH         Gc stocking full lngth 18-3000      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A653700100PGRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH         Gc stocking full lngth 30-4000      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A653800100PGRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH         Gc stocking full lngth 40-5000      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A653900100PGRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH                   Gc stocking waistlngth 18-3000      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A654000100PGRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH                   Gc stocking waistlngth 30-4000      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A654100100PGRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH                   Gc stocking waistlngth 40-5000      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A654200100PGRADIENT COMPRESSION STOCKING, CUSTOM MADE                                      Gc stocking custom made     00      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A654300100PGRADIENT COMPRESSION STOCKING, LYMPHEDEMA                                       Gc stocking lymphedema      00      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A654400100PGRADIENT COMPRESSION STOCKING, GARTER BELT                                      Gc stocking garter belt     00      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A654900100PGRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED                          G compression stocking      00      960-9              2133                                                                               M                      0072D1F P       2006010120060101        A                           
A655000100PWOUND CARE SET, FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, INCLUDES   Neg pres wound ther drsg set34      A                                                                                                     C                          D1E P       2004010120060101        C                           
A655000200QALL SUPPLIES AND ACCESSORIES                                                                                                                                                                                                                                                                                         
A655100100PCANISTER SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR Neg press wound ther canistr34      A                                                                                                     C                          D1E P       200401012006010120051231D                           
A655100200QPORTABLE, EACH                                                                                                                                                                                                                                                                                                       
A700000100PCANISTER, DISPOSABLE, USED WITH SUCTION PUMP, EACH                              Disposable canister for pump32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A700100100PCANISTER, NON-DISPOSABLE, USED WITH SUCTION PUMP, EACH                          Nondisposable pump canister 32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A700200100PTUBING, USED WITH SUCTION PUMP, EACH                                            Tubing used w suction pump  32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A700300100PADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER,          Nebulizer administration set32      A                                                                                                     C                          D1E P       2000010120000101        N                           
A700300200QDISPOSABLE                                                                                                                                                                                                                                                                                                           
A700400100PSMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, DISPOSABLE                        Disposable nebulizer sml vol32      A                                                                                                     C                          D1E P       2000010120000101        N                           
A700500100PADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER,          Nondisposable nebulizer set 32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A700500200QNON-DISPOSABLE                                                                                                                                                                                                                                                                                                       
A700600100PADMINISTRATION SET, WITH SMALL VOLUME FILTERED PNEUMATIC NEBULIZER              Filtered nebulizer admin set32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A700700100PLARGE VOLUME NEBULIZER, DISPOSABLE, UNFILLED, USED WITH AEROSOL COMPRESSOR      Lg vol nebulizer disposable 32      A                                                                                                     C                          D1E P       2000010120000101        N                           
A700800100PLARGE VOLUME NEBULIZER, DISPOSABLE, PREFILLED, USED WITH AEROSOL COMPRESSOR     Disposable nebulizer prefill32      A                                                                                                     C                          D1E P       2000010120000101        N                           
A700900100PRESERVOIR BOTTLE, NON-DISPOSABLE, USED WITH LARGE VOLUME ULTRASONIC NEBULIZER   Nebulizer reservoir bottle  32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A701000100PCORRUGATED TUBING, DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 100 FEET       Disposable corrugated tubing32      A                                                                                                     C                          D1E P       2000010120000101        N                           
A701100100PCORRUGATED TUBING, NON-DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 10 FEET    Nondispos corrugated tubing 46      A                                                                                                     C                          D1E P       2000010120000101        N                           
A701200100PWATER COLLECTION DEVICE, USED WITH LARGE VOLUME NEBULIZER                       Nebulizer water collec devic32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A701300100PFILTER, DISPOSABLE, USED WITH AEROSOL COMPRESSOR                                Disposable compressor filter32      A                                                                                                     C                          D1E P       2000010120000101        N                           
A701400100PFILTER, NONDISPOSABLE, USED WITH AEROSOL COMPRESSOR OR ULTRASONIC GENERATOR     Compressor nondispos filter 32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A701500100PAEROSOL MASK, USED WITH DME NEBULIZER                                           Aerosol mask used w nebulize32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A701600100PDOME AND MOUTHPIECE, USED WITH SMALL VOLUME ULTRASONIC NEBULIZER                Nebulizer dome & mouthpiece 32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
A701700100PNEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, NOT USED WITH   Nebulizer not used w oxygen 32      A60-9                                                                                                 D                          D1E APR     2000010120000101        N                           
A701700200QOXYGEN                                                                                                                                                                                                                                                                                                               
A701800100PWATER, DISTILLED, USED WITH LARGE VOLUME NEBULIZER, 1000 ML                     Water distilled w/nebulizer 32      A                                                                                                     C                          D1E P       2001010120010101        N                           
A701900100PSALINE SOLUTION, PER 10 ML, METERED DOSE DISPENSER, FOR USE WITH INHALATION     Saline solution dispenser   34      A                                                                                                     C                          D1E P       200101012004010120031231N                           
A701900200QDRUGS                                                                                                                                                                                                                                                                                                                
A702000100PSTERILE WATER OR STERILE SALINE, 1000 ML, USED WITH LARGE VOLUME NEBULIZER      Sterile H2O or NSS w lgv neb34      A                                                                                                     C                          D1E P       200101012004010120031231N                           
A702500100PHIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM VEST, REPLACEMENT FOR USE WITH     Replace chest compress vest 32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A702500200QPATIENT OWNED EQUIPMENT, EACH                                                                                                                                                                                                                                                                                        
A702600100PHIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM HOSE, REPLACEMENT FOR USE WITH     Replace chst cmprss sys hose32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A702600200QPATIENT OWNED EQUIPMENT, EACH                                                                                                                                                                                                                                                                                        
A703000100PFULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH                  CPAP full face mask         32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A703100100PFACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH                       Replacement facemask interfa32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A703200100PCUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH                 Replacement nasal cushion   32      A                                                                                                     C                          D1E APR     2003010120060101        C                           
A703300100PPILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR          Replacement nasal pillows   32      A                                                                                                     C                          D1E APR     2003010120060101        C                           
A703400100PNASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE       Nasal application device    32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A703400200QDEVICE, WITH OR WITHOUT HEAD STRAP                                                                                                                                                                                                                                                                                   
A703500100PHEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE                              Pos airway press headgear   32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A703600100PCHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE                             Pos airway press chinstrap  32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A703700100PTUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE                                Pos airway pressure tubing  32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A703800100PFILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE                   Pos airway pressure filter  32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A703900100PFILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE               Filter, non disposable w pap32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A704000100PONE WAY CHEST DRAIN VALVE                                                       One way chest drain valve   38      A                                                                                                     C                          D1F P       2005010120050101        N                           
A704100100PWATER SEAL DRAINAGE CONTAINER AND TUBING FOR USE WITH IMPLANTED CHEST TUBE      Water seal drain container  38      A                                                                                                     C                          D1F P       2005010120050101        N                           
A704200100PIMPLANTED PLEURAL CATHETER, EACH                                                Implanted pleural catheter  38      A                                                                                                     C                          D1F P       2003010120030101        N                           
A704300100PVACUUM DRAINAGE BOTTLE AND TUBING FOR USE WITH IMPLANTED CATHETER               Vacuum drainagebottle/tubing38      A                                                                                                     C                          D1F P       2003010120030101        N                           
A704400100PORAL INTERFACE USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH                  PAP oral interface          32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
A704500100PEXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH ACCESSORIES FOR POSITIVE       Repl exhalation port for PAP32      A60-17                                                                                                D                          D1E APR     2005010120050101        N                           
A704500200QAIRWAY DEVICES, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                     
A704600100PWATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE,        Repl water chamber, PAP dev 32      A60-17                                                                                                D                          D1E P       2004010120040101        N                           
A704600200QREPLACEMENT, EACH                                                                                                                                                                                                                                                                                                    
A750100100PTRACHEOSTOMA VALVE, INCLUDING DIAPHRAGM, EACH                                   Tracheostoma valve w diaphra37      A                  2130                                                                               D                          D1F P       2001010120010101        N                           
A750200100PREPLACEMENT DIAPHRAGM/FACEPLATE FOR TRACHEOSTOMA VALVE, EACH                    Replacement diaphragm/fplate37      A                  2130                                                                               D                          D1F P       2001010120010101        N                           
A750300100PFILTER HOLDER OR FILTER CAP, REUSABLE, FOR USE IN A TRACHEOSTOMA HEAT AND       HMES filter holder or cap   37      A                  2130                                                                               D                          D1F P       2001010120010101        N                           
A750300200QMOISTURE EXCHANGE SYSTEM, EACH                                                                                                                                                                                                                                                                                       
A750400100PFILTER FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM, EACH        Tracheostoma HMES filter    37      A                  2130                                                                               D                          D1F P       2001010120010101        N                           
A750500100PHOUSING, REUSABLE WITHOUT ADHESIVE, FOR USE IN A HEAT AND MOISTURE EXCHANGE     HMES or trach valve housing 37      A                  2130                                                                               D                          D1F P       2001010120010101        N                           
A750500200QSYSTEM AND/OR WITH A TRACHEOSTOMA VALVE, EACH                                                                                                                                                                                                                                                                        
A750600100PADHESIVE DISC FOR USE IN A HEAT AND MOISTURE EXCHANGE SYSTEM AND/OR WITH        HMES/trachvalve adhesivedisk37      A                  2130                                                                               D                          D1F P       2001010120010101        N                           
A750600200QTRACHEOSTOMA VALVE, ANY TYPE EACH                                                                                                                                                                                                                                                                                    
A750700100PFILTER HOLDER AND INTEGRATED FILTER WITHOUT ADHESIVE, FOR USE IN A TRACHEOSTOMA Integrated filter & holder  37      A                  2130                                                                               D                          D1F P       2001010120010101        N                           
A750700200QHEAT AND MOISTURE EXCHANGE SYSTEM, EACH                                                                                                                                                                                                                                                                              
A750800100PHOUSING AND INTEGRATED ADHESIVE, FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE    Housing & Integrated Adhesiv37      A                  2130                                                                               D                          D1F P       2001010120010101        N                           
A750800200QEXCHANGE SYSTEM AND/OR WITH A TRACHEOSTOMA VALVE, EACH                                                                                                                                                                                                                                                               
A750900100PFILTER HOLDER AND INTEGRATED FILTER HOUSING, AND ADHESIVE, FOR USE AS A         Heat & moisture exchange sys37      A                  2130                                                                               D                          D1F P       2001010120010101        N                           
A750900200QTRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM, EACH                                                                                                                                                                                                                                                                 
A752000100PTRACHEOSTOMY/LARYNGECTOMY TUBE, NON-CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE   Trach/laryn tube non-cuffed 37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A752000200QOR EQUAL, EACH                                                                                                                                                                                                                                                                                                       
A752100100PTRACHEOSTOMY/LARYNGECTOMY TUBE, CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE OR    Trach/laryn tube cuffed     37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A752100200QEQUAL, EACH                                                                                                                                                                                                                                                                                                          
A752200100PTRACHEOSTOMY/LARYNGECTOMY TUBE, STAINLESS STEEL OR EQUAL (STERILIZABLE AND      Trach/laryn tube stainless  37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A752200200QREUSABLE), EACH                                                                                                                                                                                                                                                                                                      
A752300100PTRACHEOSTOMY SHOWER PROTECTOR, EACH                                             Tracheostomy shower protect 37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A752400100PTRACHEOSTOMA STENT/STUD/BUTTON, EACH                                            Tracheostoma stent/stud/bttn37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A752500100PTRACHEOSTOMY MASK, EACH                                                         Tracheostomy mask           37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A752600100PTRACHEOSTOMY TUBE COLLAR/HOLDER, EACH                                           Tracheostomy tube collar    37      A                                                                                                     C                          D1F P       2004010120040101        N                           
A752700100PTRACHEOSTOMY/LARYNGECTOMY TUBE PLUG/STOP, EACH                                  Trach/laryn tube plug/stop  37      A                                                                                                     C                          D1A P       2005010120050101        N                           
A915000100PNON-PRESCRIPTION DRUGS                                                          Misc/exper non-prescript dru57      A                  2050.5                                                                             D                          O1E 9       1986010119950401        N                           
A915200100PSINGLE VITAMIN/MINERAL/TRACE ELEMENT, ORAL, PER DOSE, NOT OTHERWISE SPECIFIED   Single vitamin nos          00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
A915300100PMULTIPLE VITAMINS, WITH OR WITHOUT MINERALS AND TRACE ELEMENTS, ORAL, PER DOSE, Multi-vitamin nos           00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
A915300200QNOT OTHERWISE SPECIFIED                                                                                                                                                                                                                                                                                              
A918000100PPEDICULOSIS (LICE INFESTATION) TREATMENT, TOPICAL, FOR ADMINISTRATION BY        Lice treatment, topical     00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
A918000200QPATIENT/CARETAKER                                                                                                                                                                                                                                                                                                    
A927000100PNON-COVERED ITEM OR SERVICE                                                     Non-covered item or service 00      9                  2303                                                                               M                      0106Z2  9       1986010120020101        N                           
A927500100PHOME GLUCOSE DISPOSABLE MONITOR, INCLUDES TEST STRIPS                           Disp home glucose monitor   00      9                                                                                                     M                      0131T1E 9       2006010120060101        A                           
A928000100PALERT OR ALARM DEVICE, NOT OTHERWISE CLASSIFIED                                 Alert device, noc           00      9                                          1861                                                       S                          Z2  9       2004010120040101        N                           
A928100100PREACHING/GRABBING DEVICE, ANY TYPE, ANY LENGTH, EACH                            Reaching/grabbing device    00      9                                          1862 SSA                                                   S                          D1E APR     2006010120060101        A                           
A928200100PWIG, ANY TYPE, EACH                                                             Wig any type                00      9                                          1861SSA                                                    S                          Z2  9       2006010120060101        A                           
A930000100PEXERCISE EQUIPMENT                                                              Exercise equipment          00      960-9              2100.1                                                                             M                          Z2  9       1993010119950401        N                           
A950000100PTECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES   Tc99m sestamibi             57      A                                                                                                     C                          I1E 4       1996010120060101        B                           
A950200100PTECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES Tc99m tetrofosmin           57      A                                                                                                     C                          I1E 4       1998010120060101        B                           
A950300100PTECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES   Tc99m medronate             57      A                                                                                                     C                          I1E 4       1997010120060101        B                           
A950400100PTECHNETIUM TC-99M APCITIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES    Tc99m apcitide              57      A                                                                                                     C                          I1E 4       2000010120060101        B                           
A950500100PTHALLIUM TL-201 THALLOUS CHLORIDE, DIAGNOSTIC, PER MILLICURIE                   TL201 thallium              57      A                                                                                                     C                          I1E 4       1996010120060101        B                           
A950700100PINDIUM IN-111 CAPROMAB PENDETIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10          In111 capromab              57      A                                                                                                     C                          I1E 4       1999010120060101        B                           
A950700200QMILLICURIES                                                                                                                                                                                                                                                                                                          
A950800100PIODINE I-131 IOBENGUANE SULFATE, DIAGNOSTIC, PER 0.5 MILLICURIE                 I131 iodobenguate, dx       51      A                                                                                                     C                          I1E 4       2001010120060101        B                           
A951000100PTECHNETIUM TC-99M DISOFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES   Tc99m disofenin             51      A                                                                                                     C                          I1E 4       2001010120060101        B                           
A951100100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M,      Technetium TC 99m depreotide57      A                                                                                                     C                          I1E 4       200201012006010120051231D                           
A951100200QDEPREOTIDE, PER MCI                                                                                                                                                                                                                                                                                                  
A951200100PTECHNETIUM TC-99M PERTECHNETATE, DIAGNOSTIC, PER MILLICURIE                     Tc99m pertechnetate         57      A                                                                                                     C                          I1E 4       2003010120060101        C                           
A951300100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetium tc-99m mebrofenin57      A                                                                                                     C                          I1E 4       200301012006010120051231D                           
A951300200QMEBROFENIN, PER MCI                                                                                                                                                                                                                                                                                                  
A951400100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetiumtc99mpyrophosphate57      A                                                                                                     C                          I1E 4       200301012006010120051231D                           
A951400200QPYROPHOSPHATE, PER MCI                                                                                                                                                                                                                                                                                               
A951500100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetium tc-99m pentetate 57      A                                                                                                     C                          I1E 4       200301012006010120051231D                           
A951500200QPENTETATE, PER MCI                                                                                                                                                                                                                                                                                                   
A951600100PIODINE I-123 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC, PER 100 MICROCURIES          I123 iodide cap, dx         57      A                                                                                                     C                          I1E 4       2003010120060101        C                           
A951700100PIODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER MILLICURIE              I131 iodide cap, rx         57      A                                                                                                     C                          I1E 6       2003010120060101        C                           
A951800100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 SODIUM IODIDE    I-131 sodium iodide solution57      A                                                                            A9530                    C                          I1E 4       200301012004010120031231N                           
A951800200QSOLUTION, PER UCI                                                                                                                                                                                                                                                                                                    
A951900100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetiumtc-99mmacroag albu57      A                                                                                                     C                          I1E 4       200301012006010120051231D                           
A951900200QMACROAGGREGATED ALBUMIN, PER MCI                                                                                                                                                                                                                                                                                     
A952000100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetiumtc-99m sulfur clld57      A                                                                                                     C                          I1E 4       200301012006010120051231D                           
A952000200QSULFUR COLLOID, PER MCI                                                                                                                                                                                                                                                                                              
A952100100PTECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES Tc99m exametazime           57      A                                                                                                     C                          I1E 4       2003010120060101        C                           
A952200100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB  Indium111ibritumomabtiuxetan51      A                  15022                                                                              D                          I1E 4       200301012006010120051231D                           
A952200200QTIUXETAN, PER MCI                                                                                                                                                                                                                                                                                                    
A952300100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, YTTRIUM 90 IBRITUMOMAB Yttrium90ibritumomabtiuxetan51      A                  15022                                                                              D                          I1E 6       200301012006010120051231D                           
A952300200QTIUXETAN, PER MCI                                                                                                                                                                                                                                                                                                    
A952400100PIODINE I-131 IODINATED SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES             I131 serum albumin, dx      57      A                                                                                                     C                          I1E 4       2003010120060101        B                           
A952500100PSUPPLY OF LOW OR ISO-OSMOLAR CONTRAST MATERIAL, 10 MG OF IODINE                 Low/iso-osmolar contrast mat00      9                                                                                                     I                          I1F 4       200401012006010120051231D                           
A952600100PNITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES         Nitrogen N-13 ammonia       53      A                                                                                                     C                          I1E 4       2004010120060101        B                           
A952800100PIODINE I-131 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC, PER MILLICURIE               Iodine I-131 iodide cap, dx 57      A                                                                                                     C                          I1E 4       2004010120060101        C                           
A952900100PIODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC, PER MILLICURIE                 I131 iodide sol, dx         57      A                                                                                                     C                          I1E 4       2004010120060101        C                           
A953000100PIODINE I-131 SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE                I131 iodide sol, rx         57      A                                                                                                     C                          I1E 6       2004010120060101        C                           
A953100100PIODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER MICROCURIE (UP TO 100 MICROCURIES)  I131 max 100uCi             57      A                                                                                                     C                          I1E 4       2004010120060101        C                           
A953200100PIODINE I-125 SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES                       I125 serum albumin, dx      57      A                                                                                                     C                          I1E 6       2004010120060101        C                           
A953300100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER  I-131 tositumomab diagnostic57      A                                                                                                     C                          I1E 4       200401012006010120051231D                           
A953300200QMILLICURIE                                                                                                                                                                                                                                                                                                           
A953400100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER I-131 tositumomab therapeut 57      A                                                                                                     C                          I1E 6       200401012006010120051231D                           
A953400200QMILLICURIE                                                                                                                                                                                                                                                                                                           
A953500100PINJECTION, METHYLENE BLUE, 1 ML                                                 Injection, methylene blue   51      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A953600100PTECHNETIUM TC-99M DEPREOTIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 35 MILLICURIES  Tc99m depreotide            57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A953700100PTECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES  Tc99m mebrofenin            57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A953800100PTECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25           Tc99m pyrophosphate         57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A953800200QMILLICURIES                                                                                                                                                                                                                                                                                                          
A953900100PTECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES   Tc99m pentetate             57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A954000100PTECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 Tc99m MAA                   57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A954000200QMILLICURIES                                                                                                                                                                                                                                                                                                          
A954100100PTECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20          Tc99m sulfur colloid        57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A954100200QMILLICURIES                                                                                                                                                                                                                                                                                                          
A954200100PINDIUM IN-111 IBRITUMOMAB TIUXETAN, DIAGNOSTIC, PER STUDY DOSE, UP TO 5         In111 ibritumomab, dx       51      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A954200200QMILLICURIES                                                                                                                                                                                                                                                                                                          
A954300100PYTTRIUM Y-90 IBRITUMOMAB TIUXETAN, THERAPEUTIC, PER TREATMENT DOSE, UP TO 40    Y90 ibritumomab, rx         51      A                                                                                                     C                          I1E 6       2006010120060101        A                           
A954300200QMILLICURIES                                                                                                                                                                                                                                                                                                          
A954400100PIODINE I-131 TOSITUMOMAB, DIAGNOSTIC, PER STUDY DOSE                            I131 tositumomab, dx        57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A954500100PIODINE I-131 TOSITUMOMAB, THERAPEUTIC, PER TREATMENT DOSE                       I131 tositumomab, rx        57      A                                                                                                     C                          I1E 6       2006010120060101        A                           
A954600100PCOBALT CO-57/58, CYANOCOBALAMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURIE Co57/58                     53      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A954700100PINDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 MILLICURIE                      In111 oxyquinoline          53      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A954800100PINDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5 MILLICURIE                         In111 pentetate             53      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A954900100PTECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES Tc99m arcitumomab           53      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955000100PTECHNETIUM TC-99M SODIUM GLUCEPTATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25       Tc99m gluceptate            53      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955000200QMILLICURIE                                                                                                                                                                                                                                                                                                           
A955100100PTECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES    Tc99m succimer              53      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955200100PFLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES   F18 fdg                     53      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955300100PCHROMIUM CR-51 SODIUM CHROMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 250           Cr51 chromate               53      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955300200QMICROCURIES                                                                                                                                                                                                                                                                                                          
A955400100PIODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10           I125 iothalamate, dx        53      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955400200QMICROCURIES                                                                                                                                                                                                                                                                                                          
A955500100PRUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP TO 60 MILLICURIES                Rb82 rubidium               99      9                                                                                                     C                          I1E 4       2006010120060101        A                           
A955600100PGALLIUM GA-67 CITRATE, DIAGNOSTIC, PER MILLICURIE                               Ga67 gallium                57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955700100PTECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES    Tc99m bicisate              57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955800100PXENON XE-133 GAS, DIAGNOSTIC, PER 10 MILLICURIES                                Xe133 xenon 10mci           57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955900100PCOBALT CO-57 CYANOCOBALAMIN, ORAL, DIAGNOSTIC, PER STUDY DOSE, UP TO 1          Co57 cyano                  57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A955900200QMICROCURIE                                                                                                                                                                                                                                                                                                           
A956000100PTECHNETIUM TC-99M LABELED RED BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 Tc99m labeled rbc           57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A956000200QMILLICURIES                                                                                                                                                                                                                                                                                                          
A956100100PTECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES  Tc99m oxidronate            57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A956200100PTECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES  Tc99m mertiatide            57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A956300100PSODIUM PHOSPHATE P-32, THERAPEUTIC, PER MILLICURIE                              P32 Na phosphate            57      A                                                                                                     C                          I1E 6       2006010120060101        A                           
A956400100PCHROMIC PHOSPHATE P-32 SUSPENSION, THERAPEUTIC, PER MILLICURIE                  P32 chromic phosphate       57      A                                                                                                     C                          I1E 6       2006010120060101        A                           
A956500100PINDIUM IN-111 PENTETREOTIDE, DIAGNOSTIC, PER MILLICURIE                         In111 pentetreotide         57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A956600100PTECHNETIUM TC-99M FANOLESOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES Tc99m fanolesomab           57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A956700100PTECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, AEROSOL, PER STUDY DOSE, UP TO 75      Technetium TC-99m aerosol   57      A                                                                                                     C                          I1E 4       2006010120060101        A                           
A956700200QMILLICURIES                                                                                                                                                                                                                                                                                                          
A960000100PSTRONTIUM SR-89 CHLORIDE, THERAPEUTIC, PER MILLICURIE                           Sr89 strontium              57      A                                                                                                     C                          I1E 6       1998010120060101        C                           
A960500100PSAMARIUM SM-153 LEXIDRONAMM, THERAPEUTIC, PER 50 MILLICURIES                    Sm 153 lexidronm            57      A                                                                                                     C                          I1E 6       1999010120060101        C                           
A969800100PNON-RADIOACTIVE CONTRAST IMAGING MATERIAL, NOT OTHERWISE CLASSIFIED, PER STUDY  Non-rad contrast materialNOC51      A                  15022                                                                              D                          I1E 4       2006010120060101        A                           
A969900100PRADIOPHARMACEUTICAL, THERAPEUTIC, NOT OTHERWISE CLASSIFIED                      Radiopharm rx agent noc     57      A                                                                                                     C                          I1E 6       2003010120060101        C                           
A970000100PSUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY   Echocardiography Contrast   57      A                  15360                                                                              D                          I1E 9       2001010120010101        N                           
A990000100PMISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS  Supply/accessory/service    46      A                                                                                                     C                          D1E 9       2000010120010101        N                           
A990000200QCODE                                                                                                                                                                                                                                                                                                                 
A990100100PDME DELIVERY, SET UP, AND/OR DISPENSING SERVICE COMPONENT OF ANOTHER HCPCS CODE Delivery/set up/dispensing  46      A                                                                                                     C                          D1E 9       2000010120010101        N                           
A999900100PMISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED                  DME supply or accessory, nos46      A                                                                                                     C                          D1F 9       2004010120040101        N                           
B403400100PENTERAL FEEDING SUPPLY KIT; SYRINGE, PER DAY                                    Enter feed supkit syr by day39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B403500100PENTERAL FEEDING SUPPLY KIT;  PUMP FED, PER DAY                                  Enteral feed supp pump per d39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B403600100PENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY                                Enteral feed sup kit grav by39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B408100100PNASOGASTRIC TUBING WITH STYLET                                                  Enteral ng tubing w/ stylet 39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B408200100PNASOGASTRIC TUBING WITHOUT STYLET                                               Enteral ng tubing w/o stylet39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B408300100PSTOMACH TUBE - LEVINE TYPE                                                      Enteral stomach tube levine 39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B408600100PGASTROSTOMY / JEJUNOSTOMY TUBE, ANY MATERIAL, ANY TYPE, (STANDARD OR LOW        Gastrostomy/jejunostomy tube39      A                                                                                                     C                          O1C E       2002010120020101        N                           
B408600200QPROFILE), EACH                                                                                                                                                                                                                                                                                                       
B410000100PFOOD THICKENER, ADMINISTERED ORALLY, PER OUNCE                                  Food thickener oral         00      960-9                                                                                                 M                          Z2  E       2003010120050101        F                           
B410200100PENTERAL FORMULA, FOR ADULTS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G.      EF adult fluids and electro 39      A65-10                                                                                                D                          O1C E       2005010120050101        N                           
B410200200QCLEAR LIQUIDS), 500 ML = 1 UNIT                                                                                                                                                                                                                                                                                      
B410300100PENTERAL FORMULA, FOR PEDIATRICS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G.  EF ped fluid and electrolyte46      A65-10                                                                                                D                          O1C E       2005010120050101        N                           
B410300200QCLEAR LIQUIDS), 500 ML = 1 UNIT                                                                                                                                                                                                                                                                                      
B410400100PADDITIVE FOR ENTERAL FORMULA (E.G. FIBER)                                       Additive for enteral formula00      965-10                                                                                                D                          O1C E       2005010120050101        N                           
B414900100PENTERAL FORMULA, MANUFACTURED BLENDERIZED NATURAL FOODS WITH INTACT NUTRIENTS,  EF blenderized foods        39      A65-10             2130    4450                                                                       D                          O1C E       2005010120060101        C                           
B414900200QINCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE                                                                                                                                                                                                                                           
B414900300QFIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                           
B415000100PENTERAL FORMULA, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS, INCLUDES         EF complet w/intact nutrient39      A65-10             2130    4450                                                                       D                          O1C E       1986010120050101        N                           
B415000200QPROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER,                                                                                                                                                                                                                                             
B415000300QADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                  
B415100100PENTERAL FORMULAE; CATEGORY I; NATURAL INTACT PROTEIN/PROTEIN ISOLATES,          Enteral formulae cat1natural39      A65-10             2130    4450                                                                       D                          O1C E       198601012005010120041231N                           
B415100200QADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                  
B415200100PENTERAL FORMULA, NUTRITIONALLY COMPLETE, CALORICALLY DENSE (EQUAL TO OR GREATER EF calorie dense>/=1.5Kcal  39      A65-10             2130    4450                                                                       D                          O1C E       1984010120050101        N                           
B415200200QTHAN 1.5 KCAL/ML) WITH INTACT NUTRIENTS, INCLUDES PROTEINS, FATS,                                                                                                                                                                                                                                                    
B415200300QCARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH                                                                                                                                                                                                                                        
B415200400QAN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                                       
B415300100PENTERAL FORMULA, NUTRITIONALLY COMPLETE, HYDROLYZED PROTEINS (AMINO ACIDS AND   EF hydrolyzed/amino acids   39      A65-10             2130    4450                                                                       D                          O1C E       1986010120050101        N                           
B415300200QPEPTIDE CHAIN), INCLUDES FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY                                                                                                                                                                                                                                             
B415300300QINCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1                                                                                                                                                                                                                                        
B415300400QUNIT                                                                                                                                                                                                                                                                                                                 
B415400100PENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS, EXCLUDES  EF spec metabolic noninherit39      A65-10             2130    4450                                                                       D                          O1C E       1984010120050101        N                           
B415400200QINHERITED DISEASE OF METABOLISM, INCLUDES ALTERED COMPOSITION OF PROTEINS,                                                                                                                                                                                                                                           
B415400300QFATS, CARBOHYDRATES, VITAMINS AND/OR MINERALS, MAY INCLUDE FIBER, ADMINISTERED                                                                                                                                                                                                                                       
B415400400QTHROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                               
B415500100PENTERAL FORMULA, NUTRITIONALLY INCOMPLETE/MODULAR NUTRIENTS, INCLUDES SPECIFIC  EF incomplete/modular       39      A65-10             2130    4450                                                                       D                          O1C E       1986010120050101        N                           
B415500200QNUTRIENTS, CARBOHYDRATES (E.G. GLUCOSE POLYMERS), PROTEINS/AMINO ACIDS (E.G.                                                                                                                                                                                                                                         
B415500300QGLUTAMINE, ARGININE), FAT (E.G. MEDIUM CHAIN TRIGLYCERIDES) OR COMBINATION,                                                                                                                                                                                                                                          
B415500400QADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                  
B415600100PENTERAL FORMULAE; CATEGORY VI; STANDARDIZED NUTRIENTS, ADMINISTERED THROUGH AN  Enteral formulae category vi39      A65-10             2130    4450                                                                       D                          O1C E       198601012005010120041231N                           
B415600200QENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                                          
B415700100PENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS FOR        EF special metabolic inherit39      A65-10                                                                                                D                          O1C E       2005010120050101        N                           
B415700200QINHERITED DISEASE OF METABOLISM, INCLUDES PROTEINS, FATS, CARBOHYDRATES,                                                                                                                                                                                                                                             
B415700300QVITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL                                                                                                                                                                                                                                            
B415700400QFEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                                                  
B415800100PENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS,  EF ped complete intact nut  46      A65-10                                                                                                D                          O1C E       2005010120050101        N                           
B415800200QINCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE                                                                                                                                                                                                                                           
B415800300QFIBER AND/OR IRON, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES =                                                                                                                                                                                                                                      
B415800400Q1 UNIT                                                                                                                                                                                                                                                                                                               
B415900100PENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE SOY BASED WITH INTACT   EF ped complete soy based   46      A65-10                                                                                                D                          O1C E       2005010120050101        N                           
B415900200QNUTRIENTS, INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY                                                                                                                                                                                                                                        
B415900300QINCLUDE FIBER AND/OR IRON, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100                                                                                                                                                                                                                                         
B415900400QCALORIES = 1 UNIT                                                                                                                                                                                                                                                                                                    
B416000100PENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE CALORICALLY DENSE       EF ped caloric dense>/=0.7kc46      A65-10                                                                                                D                          O1C E       2005010120050101        N                           
B416000200Q(EQUAL TO OR GREATER THAN 0.7 KCAL/ML) WITH INTACT NUTRIENTS, INCLUDES                                                                                                                                                                                                                                               
B416000300QPROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER,                                                                                                                                                                                                                                             
B416000400QADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                  
B416100100PENTERAL FORMULA, FOR PEDIATRICS, HYDROLYZED/AMINO ACIDS AND PEPTIDE CHAIN       EF ped hydrolyzed/amino acid46      A65-10                                                                                                D                          O1C E       2005010120050101        N                           
B416100200QPROTEINS, INCLUDES FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE                                                                                                                                                                                                                                           
B416100300QFIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                           
B416200100PENTERAL FORMULA, FOR PEDIATRICS, SPECIAL METABOLIC NEEDS FOR INHERITED DISEASE  EF ped specmetabolic inherit46      A65-10                                                                                                D                          O1C E       2005010120050101        N                           
B416200200QOF METABOLISM, INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS,                                                                                                                                                                                                                                        
B416200300QMAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES =                                                                                                                                                                                                                                      
B416200400Q1 UNIT                                                                                                                                                                                                                                                                                                               
B416400100PPARENTERAL NUTRITION SOLUTION:  CARBOHYDRATES (DEXTROSE), 50% OR LESS (500 ML = Parenteral 50% dextrose solu39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B416400200Q1 UNIT) - HOMEMIX                                                                                                                                                                                                                                                                                                    
B416800100PPARENTERAL NUTRITION SOLUTION; AMINO ACID, 3.5%, (500 ML = 1 UNIT) - HOMEMIX    Parenteral sol amino acid 3.39      A65-10             2130    4450                                                                       D                          O1C E       1984010120020101        N                           
B417200100PPARENTERAL 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       1984010120020101        N                           
B417200200QHOMEMIX                                                                                                                                                                                                                                                                                                              
B417600100PPARENTERAL 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       1986010120020101        N                           
B417600200QHOMEMIX                                                                                                                                                                                                                                                                                                              
B417800100PPARENTERAL NUTRITION SOLUTION: AMINO ACID, GREATER THAN 8.5% (500 ML = 1 UNIT)  Parenteral sol amino acid > 39      A65-10             2130    4450                                                                       D                          O1C E       1988010120020101        N                           
B417800200Q- HOMEMIX                                                                                                                                                                                                                                                                                                            
B418000100PPARENTERAL NUTRITION SOLUTION; CARBOHYDRATES (DEXTROSE), GREATER THAN 50% (500  Parenteral sol carb > 50%   39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B418000200QML=1 UNIT) - HOMEMIX                                                                                                                                                                                                                                                                                                 
B418400100PPARENTERAL NUTRITION SOLUTION; LIPIDS, 10% WITH ADMINISTRATION SET (500 ML = 1  Parenteral sol lipids 10%   39      A65-10             2130    4450                                                                       D                          O1C E       198401012006010120051231D                           
B418400200QUNIT)                                                                                                                                                                                                                                                                                                                
B418500100PPARENTERAL NUTRITION SOLUTION, PER 10 GRAMS LIPIDS                              Parenteral sol 10 gm lipids 39      A                                                                                                     D                      0126O1C E       2006010120060101        A                           
B418600100PPARENTERAL NUTRITION SOLUTION, LIPIDS, 20% WITH ADMINISTRATION SET (500 ML = 1  Parenteral sol lipids 20%   39      A65-10             2130    4450                                                                       D                          O1C E       198601012006010120051231D                           
B418600200QUNIT)                                                                                                                                                                                                                                                                                                                
B418900100PPARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol amino acid & 39      A65-10             2130    4450                                                                       D                          O1C E       1988010120020101        N                           
B418900200QELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B418900300QSTRENGTH, 10 TO 51 GRAMS OF PROTEIN - PREMIX                                                                                                                                                                                                                                                                         
B419300100PPARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol 52-73 gm prot39      A65-10             2130    4450                                                                       D                          O1C E       1988010120020101        N                           
B419300200QELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B419300300QSTRENGTH, 52 TO 73 GRAMS OF PROTEIN - PREMIX                                                                                                                                                                                                                                                                         
B419700100PPARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol 74-100 gm pro39      A65-10             2130    4450                                                                       D                          O1C E       1988010120020101        N                           
B419700200QELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH,                                                                                                                                                                                                                                      
B419700300Q74 TO 100 GRAMS OF PROTEIN - PREMIX                                                                                                                                                                                                                                                                                  
B419900100PPARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol > 100gm prote39      A65-10             2130    4450                                                                       D                          O1C E       1988010120020101        N                           
B419900200QELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH,                                                                                                                                                                                                                                      
B419900300QOVER 100 GRAMS OF PROTEIN - PREMIX                                                                                                                                                                                                                                                                                   
B421600100PPARENTERAL NUTRITION; ADDITIVES (VITAMINS, TRACE ELEMENTS, HEPARIN,             Parenteral nutrition additiv39      A65-10             2130    4450                                                                       D                          O1C E       1984010120020101        N                           
B421600200QELECTROLYTES) HOMEMIX PER DAY                                                                                                                                                                                                                                                                                        
B422000100PPARENTERAL NUTRITION SUPPLY KIT; PREMIX, PER DAY                                Parenteral supply kit premix39      A65-10             2130    4450                                                                       D                          O1C E       1984010120020101        N                           
B422200100PPARENTERAL NUTRITION SUPPLY KIT; HOME MIX, PER DAY                              Parenteral supply kit homemi39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B422400100PPARENTERAL NUTRITION ADMINISTRATION KIT, PER DAY                                Parenteral administration ki39      A65-10             2130    4450                                                                       D                          O1C E       1986010120020101        N                           
B500000100PPARENTERAL NUTRITION SOLUTION:  COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH    Parenteral sol renal-amirosy39      A65-10             2130    4450                                                                       D                          O1C E       1988010120020101        N                           
B500000200QELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B500000300QSTRENGTH, RENAL - AMIROSYN RF, NEPHRAMINE, RENAMINE - PREMIX                                                                                                                                                                                                                                                         
B510000100PPARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol hepatic-fream39      A65-10             2130    4450                                                                       D                          O1C E       1988010120020101        N                           
B510000200QELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B510000300QSTRENGTH, HEPATIC - FREAMINE HBC, HEPATAMINE - PREMIX                                                                                                                                                                                                                                                                
B520000100PPARENTERAL NUTRITION SOLUTION:  COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH    Parenteral sol stres-brnch c39      A65-10             2130    4450                                                                       D                          O1C E       1988010120020101        N                           
B520000200QELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B520000300QSTRENGTH, STRESS - BRANCH CHAIN AMINO ACIDS - PREMIX                                                                                                                                                                                                                                                                 
B900000100PENTERAL NUTRITION INFUSION PUMP - WITHOUT ALARM                                 Enter infusion pump w/o alrm39      A65-10             2130    4450                                                                       D                          O1C APR     1988010120020101        N                           
B900200100PENTERAL NUTRITION INFUSION PUMP - WITH ALARM                                    Enteral infusion pump w/ ala39      A65-10             2130    4450                                                                       D                          O1C APR     1988010120020101        N                           
B900400100PPARENTERAL NUTRITION INFUSION PUMP, PORTABLE                                    Parenteral infus pump portab39      A65-10             2130    4450                                                                       D                          O1C APR     1988010120020101        N                           
B900600100PPARENTERAL NUTRITION INFUSION PUMP, STATIONARY                                  Parenteral infus pump statio39      A65-10             2130    4450                                                                       D                          O1C APR     1988010120020101        N                           
B999800100PNOC FOR ENTERAL SUPPLIES                                                        Enteral supp not otherwise c57      A65-10             2130    4450                                                                       D                          O1C E       1985010119960101        N                           
B999900100PNOC FOR PARENTERAL SUPPLIES                                                     Parenteral supp not othrws c57      A65-10             2130    4450                                                                       D                          O1C E       1985010119960101        N                           
C101000100PWHOLE BLOOD OR RED BLOOD CELLS, LEUKOREDUCED, CMV NEGATIVE, EACH UNIT           Blood, L/R, CMV-NEG         53      A                                          1833(T)                                                    D                      0093T1H 0       200008012004010120031231N                           
C101100100PPLATELET, HLA-MATCHED LEUKOREDUCED, APHERESIS/PHERESIS, EACH UNIT               Platelets, HLA-m, L/R, unit 53      A                                          1833(T)                                                    D                      0093T1H 0       200008012004010120031231N                           
C101200100PPLATELET CONCENTRATE, LEUKOREDUCED, IRRADIATED, EACH UNIT                       PLATELET CONC, L/R, Irrad   53      A                                          1833(T)                           P9033                    D                      0093D1A 9       200008012003010120021231N                           
C101300100PPLATELET CONCENTRATE, LEUKOREDUCED, EACH UNIT                                   PLATELET CONC, L/R, Unit    53      A                                          1833(T)                           P9031                    D                      0093D1A 9       200008012003010120021231N                           
C101400100PPLATELET, LEUKOREDUCED, APHERESIS/PHERESIS, EACH UNIT                           Platelet,Aph/Pher, L/R, unit53      A                                          1833(T)                           P9035                    D                      0093D1A 9       200008012003010120021231N                           
C101500100PPLATELETS, PHERESIS, LEUKOCYTE-REDUCED, CMV NEGATIVE, IRRADIATED, EACH UNIT     Plt, pher,L/R,CMV, irrad    53      A                                          1833(t)                                                    D                      0093T1H 0       200301012004010120031231N                           
C101600100PWHOLE BLOOD OR RED BLOOD CELLS, LEUKOREDUCED, FROZEN, DEGLYCEROL, WASHED, EACH  BLOOD,L/R,FROZ/DEGLY/Washed 53      A                                          1833(T)                                                    D                      0093T1H 0       200008012004010120031231N                           
C101600200QUNIT                                                                                                                                                                                                                                                                                                                 
C101700100PPLATELET, LEUKOREDUCED, CMV-NEGATIVE, APHERESIS/PHERESIS, EACH UNIT             Plt, APH/PHER,L/R,CMV-NEG   53      A                                          1833(T)                                                    D                      0093T1H 0       200008012004010120031231N                           
C101800100PWHOLE BLOOD, LEUKOREDUCED, IRRADIATED, EACH UNIT                                Blood, L/R, IRRADIATED      53      A                                          1833(T)                                                    D                      0093T1H 0       200008012004010120031231N                           
C102000100PRED BLOOD CELLS, FROZEN/DEGLYCEROLIZED/WASHED, LEUKOCYTE-REDUCED, IRRADIATED,   RBC, frz/deg/wsh, L/R, irrad53      A                                          1833(T)                                                    D                      0093T1H 0       200301012004010120031231N                           
C102000200QEACH UNIT                                                                                                                                                                                                                                                                                                            
C102100100PRED BLOOD CELLS, LEUKOCYTE-REDUCED, CMV NEGATIVE, IRRADIATED, EACH UNIT         RBC, L/R, CMV neg, irrad    53      A                                          1833(T)                                                    D                      0093T1H 0       200301012004010120031231N                           
C102200100PPLASMA, FROZEN WITHIN 24 HOURS OF COLLECTION, EACH UNIT                         Plasma, frz within 24 hour  53      A                                          1833(T)                                                    D                      0093T1H 9       200301012004010120031231N                           
C105800100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M oxidronate, per vial 53      A                                          1833(T)                           Q3009                    D                      0093I1E 4       200201012003010120021231N                           
C105800200QOXIDRONATE, PER VIAL                                                                                                                                                                                                                                                                                                 
C106400100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, SODIUM IODIDE I-131,   I-131 cap, each add mCi     53      A                                          1833(T)                                                    D                      0093I1E 4       200201012003010120021231N                           
C106400200QCAPSULE, EACH ADDITIONAL MCI                                                                                                                                                                                                                                                                                         
C106500100PSUPPLY OF RADIOPHARMACUETICAL THERAPEUTIC IMAGING AGENT, SODIUM IODIDE I-131,   I-131 sol, each add mCi     53      A                                          1833(T)                                                    D                      0093I1E 4       200201012003010120021231N                           
C106500200QSOLUTION, EACH ADDITIONAL MCI                                                                                                                                                                                                                                                                                        
C106600100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 SATUMOMAB    IN 111 satumomab pendetide  53      A                                          1833(T)                           A4642                    D                      0093I1E 4       200201012003010120021231N                           
C106600200QPENDETIDE, PER VIAL                                                                                                                                                                                                                                                                                                  
C107900100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CYANOCOBALAMIN CO       CO 57/58 per 0.5 uCi        53      A                                          1833(T)                           A9546                    D                      0093I1E 4       200008012006010120051231D                           
C107900200Q57/58, PER 0.5 MICROCURIE                                                                                                                                                                                                                                                                                            
C108000100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER  I-131 tositumomab, dx       53      A                                          1833T                             A9544                    D                          I1E 4       200401012006010120051231D                           
C108000200QDOSE                                                                                                                                                                                                                                                                                                                 
C108100100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER I-131 tositumomab, tx       53      A                                          1833T                             A9545                    D                      0093I1E 6       200401012006010120051231D                           
C108100200QDOSE                                                                                                                                                                                                                                                                                                                 
C108200100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB  In-111 ibritumomab tiuxetan 53      A                                          1833T                             A9542                    D                      0093I1E 4       200401012006010120051231D                           
C108200200QTIUXETAN, PER DOSE                                                                                                                                                                                                                                                                                                   
C108300100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, YTTRIUM 90 IBRITUMOMAB Yttrium 90 ibritumomab tiuxe53      A                                          1833T                             A9543                    D                      0093I1E 6       200401012006010120051231D                           
C108300200QTIUXETAN, PER DOSE                                                                                                                                                                                                                                                                                                   
C108700100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM IODIDE 1-123 PER I-123 per 100 uCi           53      A                                          1833(T)                                                    D                      0093I1E 4       200008012003010120021231N                           
C108700200Q100 MICROCURIES                                                                                                                                                                                                                                                                                                      
C108800100PLASER OPTIC TREATMENT SYSTEM, INDIGO LASEROPTIC TREATMENT SYSTEM                LASER OPTIC TR Sys          53      A                                          1833(T)                                                    D                      0093P1G 9       200008012004010120031231N                           
C109100100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111              IN111 oxyquinoline,per0.5mCi53      A                                          1833(T)                           A9547                    D                      0093I1E 4       200008012006010120051231D                           
C109100200QOXYQUINOLINE, PER 0.5 MILLICURIE                                                                                                                                                                                                                                                                                     
C109200100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 PENTETATE,   IN 111 pentetate per 0.5 mCi53      A                                          1833(T)                           A9548                    D                      0093I1E 4       200008012006010120051231D                           
C109200200QPER 0.5 MILLICURIE                                                                                                                                                                                                                                                                                                   
C109300100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC99M fanolesomab           53      A                                          1833(T)                           A9566                    D                          I1F 4       200501012006010120051231D                           
C109300200QFANOLESOMAB, PER DOSE (10 - 20 MCI)                                                                                                                                                                                                                                                                                  
C109400100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC99Malbumin aggr,per 1.0mCi53      A                                          1833(T)                                                    D                      0093I1E 4       200008012003010120021231N                           
C109400200QALBUMIN AGGREGATED, PER 1.0 MILLICURIE                                                                                                                                                                                                                                                                               
C109600100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M EXAMETAZIME, PER Dose53      A                                          1833(T)                                                    D                      0093I1E 4       200008012003010120021231N                           
C109600200QEXAMETAZIME, PER DOSE                                                                                                                                                                                                                                                                                                
C109700100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M MEBROFENIN, PER Vial 53      A                                          1833(T)                                                    D                      0093I1E 4       200008012003010120021231N                           
C109700200QMEBROFENIN, PER VIAL                                                                                                                                                                                                                                                                                                 
C109800100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M PENTETATE, PER Vial  53      A                                          1833(T)                                                    D                      0093I1E 4       200008012003010120021231N                           
C109800200QPENTETATE, PER VIAL                                                                                                                                                                                                                                                                                                  
C109900100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M PYROPHOSPHATE,PER Via53      A                                          1833(T)                                                    D                      0093I1E 4       200008012003010120021231N                           
C109900200QPYROPHOSPHATE, PER VIAL                                                                                                                                                                                                                                                                                              
C112200100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       Tc 99M ARCITUMOMAB PER VIAL 53      A                                          1833(T)                           A9549                    D                      0093I1E 4       200008012006010120051231D                           
C112200200QARCITUMOMAB, PER VIAL                                                                                                                                                                                                                                                                                                
C116600100PINJECTION, CYTARABINE LIPOSOME, PER 10 MG                                       CYTARABINE LIPOSOMAL, 10 mg 53      A                                          1833(T)                                                    D                      0093O1E 1P      200008012004010120031231N                           
C116700100PINJECTION, EPIRUBICIN HYDROCHLORIDE, 2 MG                                       EPIRUBICIN HCL, 2 mg        53      A                                          1833(T)                                                    D                      0093O1D 1P      200008012004010120031231N                           
C117800100PINJECTION, BUSULFAN, PER 6 MG                                                   BUSULFAN IV, 6 Mg           51      A                                          1833(T)                                                    D                      0093O1D 1P      2000080120030701        N                           
C118800100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, SODIUM IODIDE I-131,   I-131 cap, per 1-5 mCi      53      A                                          1833(T)                                                    D                      0093I1E 4       200008012003010120021231N                           
C118800200QCAPSULE, PER INITIAL 1-5 MCI                                                                                                                                                                                                                                                                                         
C120000100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M Sodium Glucoheptonat 53      A                                          1833(T)                                                    D                      0093I1E 4       200008012006010120051231D                           
C120000200QSODIUM GLUCOHEPTONATE, PER VIAL                                                                                                                                                                                                                                                                                      
C120100100PSUPPLY OF RADIOPHARMACEUTICAL  DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M      TC 99M SUCCIMER, PER Vial   53      A                                          1833(T)                           A9551                    D                      0093I1E 4       200008012006010120051231D                           
C120100200QSUCCIMER, PER VIAL                                                                                                                                                                                                                                                                                                   
C120200100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M SULFUR COLLOID, Vial 53      A                                          1833(T)                                                    D                      0093I1E 4       200008012003010120021231N                           
C120200200QSULFUR COLLOID, PER DOSE                                                                                                                                                                                                                                                                                             
C120700100POCTREOTIDE ACETATE, 1 MG                                                        OCTREOTIDE ACETATE DEPOT 1mg53      A                                          1833(T)                                                    D                      0093O1E 9       200008012003070120030630N                           
C130000100PHYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL     HYPERBARIC Oxygen           53      A                                          1833(T)                                                    D                      0093P5E 9       2000080120030701        N                           
C130500100PGRAFTSKIN, PER 44 SQUARE CENTIMETERS                                            Apligraf                    53      A                                          1833(T)                           J7340                    D                      0093D1A 9       200008012006010120051231D                           
C134800100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, SODIUM IODIDE I-131,   I-131 sol, per 1-6 mCi      53      A                                          1833(T)                                                    D                      0093I1E 4       200008012003010120021231N                           
C134800200QSOLUTION, PER INITIAL 1-6 MCI                                                                                                                                                                                                                                                                                        
C171300100PANCHOR/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      2001040120040101        N                           
C171400100PCATHETER, TRANSLUMINAL ATHERECTOMY, DIRECTIONAL                                 Cath, trans atherectomy, dir53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C171500100PBRACHYTHERAPY NEEDLE                                                            Brachytherapy needle        53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C171600100PBRACHYTHERAPY SOURCE, GOLD 198, PER SOURCE                                      Brachytx source, Gold 198   53      A                                          1833(T)                                                    D                          D1A 9S      2001040120050101        N                           
C171700100PBRACHYTHERAPY SOURCE, HIGH DOSE RATE IRIDIUM 192, PER SOURCE                    Brachytx source, HDR Ir-192 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120050101        N                           
C171800100PBRACHYTHERAPY SOURCE, IODINE 125, PER SOURCE                                    Brachytx source, Iodine 125 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120050101        N                           
C171900100PBRACHYTHERAPY SOURCE, NON-HIGH DOSE RATE IRIDIUM 192, PER SOURCE                Brachytx sour,Non-HDR Ir-19253      A                                          1833(T)                                                    D                          D1A 9S      2001040120050101        N                           
C172000100PBRACHYTHERAPY SOURCE, PALLADIUM 103, PER SOURCE                                 Brachytx sour, Palladium 10353      A                                          1833(T)                                                    D                          D1A 9S      2001040120050101        N                           
C172100100PCARDIOVERTER-DEFIBRILLATOR, DUAL CHAMBER (IMPLANTABLE)                          AICD, dual chamber          53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C172200100PCARDIOVERTER-DEFIBRILLATOR, SINGLE CHAMBER (IMPLANTABLE)                        AICD, single chamber        53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C172400100PCATHETER, TRANSLUMINAL ATHERECTOMY, ROTATIONAL                                  Cath, trans atherec,rotation53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C172500100PCATHETER, TRANSLUMINAL ANGIOPLASTY, NON-LASER (MAY INCLUDE GUIDANCE,            Cath, translumin non-laser  53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C172500200QINFUSION/PERFUSION CAPABILITY)                                                                                                                                                                                                                                                                                       
C172600100PCATHETER, BALLOON DILATATION, NON-VASCULAR                                      Cath, bal dil, non-vascular 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C172700100PCATHETER, BALLOON TISSUE DISSECTOR, NON-VASCULAR (INSERTABLE)                   Cath, bal tis dis, non-vas  53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C172800100PCATHETER, BRACHYTHERAPY SEED ADMINISTRATION                                     Cath, brachytx seed adm     53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C172900100PCATHETER, DRAINAGE                                                              Cath, drainage              53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C173000100PCATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (19 OR FEWER     Cath, EP, 19 or few elect   53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C173000200QELECTRODES)                                                                                                                                                                                                                                                                                                          
C173100100PCATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (20 OR MORE      Cath, EP, 20 or more elec   53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C173100200QELECTRODES)                                                                                                                                                                                                                                                                                                          
C173200100PCATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, 3D OR VECTOR MAPPING          Cath, EP, diag/abl, 3D/vect 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C173300100PCATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, OTHER THAN 3D OR VECTOR       Cath, EP, othr than cool-tip53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C173300200QMAPPING, OTHER THAN COOL-TIP                                                                                                                                                                                                                                                                                         
C175000100PCATHETER, HEMODIALYSIS, LONG-TERM                                               Cath, hemodialysis,long-term53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C175100100PCATHETER, INFUSION, INSERTED PERIPHERALLY, CENTRALLY OR MIDLINE (OTHER THAN     Cath, inf, per/cent/midline 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C175100200QHEMODIALYSIS)                                                                                                                                                                                                                                                                                                        
C175200100PCATHETER, HEMODIALYSIS, SHORT-TERM                                              Cath,hemodialysis,short-term53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C175300100PCATHETER, INTRAVASCULAR ULTRASOUND                                              Cath, intravas ultrasound   53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C175400100PCATHETER, INTRADISCAL                                                           Catheter, intradiscal       53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C175500100PCATHETER, INTRASPINAL                                                           Catheter, intraspinal       53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C175600100PCATHETER, PACING, TRANSESOPHAGEAL                                               Cath, pacing, transesoph    53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C175700100PCATHETER, THROMBECTOMY/EMBOLECTOMY                                              Cath, thrombectomy/embolect 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C175800100PCATHETER, URETERAL                                                              Catheter, ureteral          53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C175900100PCATHETER, INTRACARDIAC ECHOCARDIOGRAPHY                                         Cath, intra echocardiography53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C176000100PCLOSURE DEVICE, VASCULAR (IMPLANTABLE/INSERTABLE)                               Closure dev, vasc           53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C176200100PCONNECTIVE TISSUE, HUMAN (INCLUDES FASCIA LATA)                                 Conn tiss, human(inc fascia)53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C176300100PCONNECTIVE TISSUE, NON-HUMAN (INCLUDES SYNTHETIC)                               Conn tiss, non-human        53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C176400100PEVENT RECORDER, CARDIAC (IMPLANTABLE)                                           Event recorder, cardiac     53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C176500100PADHESION BARRIER                                                                Adhesion barrier            53      A                                          1833(T)                                                    D                          D1A 9S      2001070120010701        N                           
C176600100PINTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, STEERABLE, OTHER Intro/sheath,strble,non-peel53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C176600200QTHAN PEEL-AWAY                                                                                                                                                                                                                                                                                                       
C176700100PGENERATOR, NEUROSTIMULATOR (IMPLANTABLE)                                        Generator, neurostim, imp   53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C176800100PGRAFT, VASCULAR                                                                 Graft, vascular             53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C176900100PGUIDE WIRE                                                                      Guide wire                  53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C177000100PIMAGING COIL, MAGNETIC RESONANCE (INSERTABLE)                                   Imaging coil, MR, insertable53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C177100100PREPAIR DEVICE, URINARY, INCONTINENCE, WITH SLING GRAFT                          Rep dev, urinary, w/sling   53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C177200100PINFUSION PUMP, PROGRAMMABLE (IMPLANTABLE)                                       Infusion pump, programmable 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C177300100PRETRIEVAL DEVICE, INSERTABLE (USED TO RETRIEVE FRACTURED MEDICAL DEVICES)       Ret dev, insertable         53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C177400100PINJECTION, DARBEPOETIN ALFA (FOR NON ESRD USE), PER 1 MCG                       Darbepoetin alfa, non-esrd  53      A                                          1833(T)                                                    D                          O1E 9       200201012004010120031231N                           
C177500100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, FLUORODEOXYGLUCOSE F18  FDG, per dose (4-40 mCi/ml) 53      A                                          1833(T)                           A9552                    D                          I2D 4       200204012006010120051231D                           
C177500200Q(2-DEOXY-2-[18F]FLUORO-D-GLUCOSE), PER DOSE (4-40 MCI/ML)                                                                                                                                                                                                                                                            
C177600100PJOINT DEVICE (IMPLANTABLE)                                                      Joint device (implantable)  53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C177700100PLEAD, CARDIOVERTER-DEFIBRILLATOR, ENDOCARDIAL SINGLE COIL (IMPLANTABLE)         Lead, AICD, endo single coil53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C177800100PLEAD, NEUROSTIMULATOR (IMPLANTABLE)                                             Lead, neurostimulator       53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C177900100PLEAD, PACEMAKER, TRANSVENOUS VDD SINGLE PASS                                    Lead, pmkr, transvenous VDD 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C178000100PLENS, INTRAOCULAR (NEW TECHNOLOGY)                                              Lens, intraocular (new tech)53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C178100100PMESH (IMPLANTABLE)                                                              Mesh (implantable)          53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C178200100PMORCELLATOR                                                                     Morcellator                 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C178300100POCULAR IMPLANT, AQUEOUS DRAINAGE ASSIST DEVICE                                  Ocular imp, aqueous drain de53      A                                          1833(T)                                                    D                          D1A 9S      2002070120020701        N                           
C178400100POCULAR DEVICE, INTRAOPERATIVE, DETACHED RETINA                                  Ocular dev, intraop, det ret53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C178500100PPACEMAKER, DUAL CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)                          Pmkr, dual, rate-resp       53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C178600100PPACEMAKER, SINGLE CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)                        Pmkr, single, rate-resp     53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C178700100PPATIENT PROGRAMMER, NEUROSTIMULATOR                                             Patient progr, neurostim    53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C178800100PPORT, INDWELLING (IMPLANTABLE)                                                  Port, indwelling, imp       53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C178900100PPROSTHESIS, BREAST (IMPLANTABLE)                                                Prosthesis, breast, imp     53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C181300100PPROSTHESIS, PENILE, INFLATABLE                                                  Prosthesis, penile, inflatab53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C181400100PRETINAL TAMPONADE DEVICE, SILICONE OIL                                          Retinal tamp, silicone oil  53      A                                          1833t                                                      D                          D1A 9S      2003040120030401        N                           
C181500100PPROSTHESIS, URINARY SPHINCTER (IMPLANTABLE)                                     Pros, urinary sph, imp      53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C181600100PRECEIVER AND/OR TRANSMITTER, NEUROSTIMULATOR (IMPLANTABLE)                      Receiver/transmitter, neuro 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C181700100PSEPTAL DEFECT IMPLANT SYSTEM, INTRACARDIAC                                      Septal defect imp sys       53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C181800100PINTEGRATED KERATOPROSTHESIS                                                     Integrated keratoprosthesis 53      A                                          1833T                                                      D                          D1A 9S      2003070120030701        N                           
C181900100PSURGICAL TISSUE LOCALIZATION AND EXCISION DEVICE (IMPLANTABLE)                  Tissue localization-excision53      A                                          1833T                                                      D                      0093D1A 9S      2004010120040101        N                           
C187400100PSTENT, COATED/COVERED, WITH DELIVERY SYSTEM                                     Stent, coated/cov w/del sys 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C187500100PSTENT, COATED/COVERED, WITHOUT DELIVERY SYSTEM                                  Stent, coated/cov w/o del sy53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C187600100PSTENT, NON-COATED/NON-COVERED, WITH DELIVERY SYSTEM                             Stent, non-coa/non-cov w/del53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C187700100PSTENT, NON-COATED/NON-COVERED, WITHOUT DELIVERY SYSTEM                          Stent, non-coat/cov w/o del 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C187800100PMATERIAL FOR VOCAL CORD MEDIALIZATION, SYNTHETIC (IMPLANTABLE)                  Matrl for vocal cord        53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C187900100PTISSUE MARKER (IMPLANTABLE)                                                     Tissue marker, implantable  53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C188000100PVENA CAVA FILTER                                                                Vena cava filter            53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C188100100PDIALYSIS ACCESS SYSTEM (IMPLANTABLE)                                            Dialysis access system      53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C188200100PCARDIOVERTER-DEFIBRILLATOR, OTHER THAN SINGLE OR DUAL CHAMBER (IMPLANTABLE)     AICD, other than sing/dual  53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C188300100PADAPTOR/EXTENSION, PACING LEAD OR NEUROSTIMULATOR LEAD (IMPLANTABLE)            Adapt/ext, pacing/neuro lead53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C188400100PEMBOLIZATION PROTECTIVE SYSTEM                                                  Embolization Protect syst   53      A                                          1833T                                                      D                          D1A 9S      2003010120030101        N                           
C188500100PCATHETER, TRANSLUMINAL ANGIOPLASTY, LASER                                       Cath, translumin angio laser53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C188700100PCATHETER, GUIDING (MAY INCLUDE INFUSION/PERFUSION CAPABILITY)                   Catheter, guiding           53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C188800100PCATHETER, ABLATION, NON-CARDIAC, ENDOVASCULAR (IMPLANTABLE)                     Endovas non-cardiac abl cath53      A                                          1833(T)                                                    D                          D1A 9S      2002070120020701        N                           
C189100100PINFUSION PUMP, NON-PROGRAMMABLE, PERMANENT (IMPLANTABLE)                        Infusion pump,non-prog, perm53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C189200100PINTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE,     Intro/sheath,fixed,peel-away53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C189200200QPEEL-AWAY                                                                                                                                                                                                                                                                                                            
C189300100PINTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE,     Intro/sheath, fixed,non-peel53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C189300200QOTHER THAN PEEL-AWAY                                                                                                                                                                                                                                                                                                 
C189400100PINTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC                  Intro/sheath, non-laser     53      A                                          1833(T)                                                    D                          D1A 9S      2001040120020701        C                           
C189400200QELECTROPHYSIOLOGICAL, NON-LASER                                                                                                                                                                                                                                                                                      
C189500100PLEAD, CARDIOVERTER-DEFIBRILLATOR, ENDOCARDIAL DUAL COIL (IMPLANTABLE)           Lead, AICD, endo dual coil  53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C189600100PLEAD, CARDIOVERTER-DEFIBRILLATOR, OTHER THAN ENDOCARDIAL SINGLE OR DUAL COIL    Lead, AICD, non sing/dual   53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C189600200Q(IMPLANTABLE)                                                                                                                                                                                                                                                                                                        
C189700100PLEAD, NEUROSTIMULATOR TEST KIT (IMPLANTABLE)                                    Lead, neurostim test kit    53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C189800100PLEAD, PACEMAKER, OTHER THAN TRANSVENOUS VDD SINGLE PASS                         Lead, pmkr, other than trans53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C189900100PLEAD, PACEMAKER/CARDIOVERTER-DEFIBRILLATOR COMBINATION (IMPLANTABLE)            Lead, pmkr/AICD combination 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C190000100PLEAD, LEFT VENTRICULAR CORONARY VENOUS SYSTEM                                   Lead, coronary venous       53      A                                          1833(T)                                                    D                          D1A 9S      2002070120020701        N                           
C261400100PPROBE, PERCUTANEOUS LUMBAR DISCECTOMY                                           Probe, perc lumb disc       53      A                                          1833(T)                                                    D                      0093D1A 9S      2003010120030101        N                           
C261500100PSEALANT, PULMONARY, LIQUID                                                      Sealant, pulmonary, liquid  53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C261600100PBRACHYTHERAPY SOURCE, YTTRIUM-90, PER SOURCE                                    Brachytx source, Yttrium-90 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120050101        N                           
C261700100PSTENT, NON-CORONARY, TEMPORARY, WITHOUT DELIVERY SYSTEM                         Stent, non-cor, tem w/o del 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C261800100PPROBE, CRYOABLATION                                                             Probe, cryoablation         53      A                                          1833(T)                                                    D                          D1A 9S      2001040120010401        N                           
C261900100PPACEMAKER, DUAL CHAMBER, NON RATE-RESPONSIVE (IMPLANTABLE)                      Pmkr, dual, non rate-resp   53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C262000100PPACEMAKER, SINGLE CHAMBER, NON RATE-RESPONSIVE (IMPLANTABE)                     Pmkr, single, non rate-resp 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C262100100PPACEMAKER, OTHER THAN SINGLE OR DUAL CHAMBER (IMPLANTABLE)                      Pmkr, other than sing/dual  53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C262200100PPROSTHESIS, PENILE, NON-INFLATABLE                                              Prosthesis, penile, non-inf 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C262500100PSTENT, NON-CORONARY, TEMPORARY, WITH DELIVERY SYSTEM                            Stent, non-cor, tem w/del sy53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C262600100PINFUSION PUMP, NON-PROGRAMMABLE, TEMPORARY (IMPLANTABLE)                        Infusion pump, non-prog,temp53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C262700100PCATHETER, SUPRAPUBIC/CYSTOSCOPIC                                                Cath, suprapubic/cystoscopic53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C262800100PCATHETER, OCCLUSION                                                             Catheter, occlusion         53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C262900100PINTRODUCER/SHEATH, OTHER THAN GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, LASER Intro/sheath, laser         53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C263000100PCATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, OTHER THAN 3D OR VECTOR       Cath, EP, cool-tip          53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C263000200QMAPPING, COOL-TIP                                                                                                                                                                                                                                                                                                    
C263100100PREPAIR DEVICE, URINARY, INCONTINENCE, WITHOUT SLING GRAFT                       Rep dev, urinary, w/o sling 53      A                                          1833(T)                                                    D                          D1A 9S      2001040120040101        N                           
C263200100PBRACHYTHERAPY SOLUTION, IODINE-125, PER MCI                                     Brachytx sol, I-125, per mCi53      A                                          1833(T)                                                    D                      0093D1A 9       2003010120030101        N                           
C263300100PBRACHYTHERAPY SOURCE, CESIUM-131, PER SOURCE                                    Brachytx source, Cesium-131 53      A                                          1833T                                                      D                      0093D1A 9S      2004010120050101        N                           
C263400100PBRACHYTHERAPY SOURCE, HIGH ACTIVITY, IODINE-125, GREATER THAN  1.01 MCI (NIST), Brachytx source, HA, I-125  53      A                                          1833(T)                                                    D                          D1A 9       2005010120050101        C                           
C263400200QPER SOURCE                                                                                                                                                                                                                                                                                                           
C263500100PBRACHYTHERAPY SOURCE, HIGH ACTIVITY, PALADIUM-103, GREATER THAN  2.2 MCI        Brachytx source, HA, P-103  53      A                                          1833(T)                                                    D                          D1A 9       2005010120050101        C                           
C263500200Q(NIST), PER SOURCE                                                                                                                                                                                                                                                                                                   
C263600100PBRACHYTHERAPY LINEAR SOURCE, PALADIUM-103, PER 1 MM                             Brachytx linear source,P-10353      A                                          1833(T)                                                    D                          D1A 9       2005010120050101        N                           
C263700100PBRACHYTHERAPY SOURCE, YTTERBIUM-169, PER SOURCE                                 Brachytx, Ytterbium-169     53      A                                          1833(T)                                                    D                          I1E 4       2005100120051001        A                           
C890000100PMAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, ABDOMEN                           MRA w/cont, abd             53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C890100100PMAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, ABDOMEN                        MRA w/o cont, abd           53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C890200100PMAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,      MRA w/o fol w/cont, abd     53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C890200200QABDOMEN                                                                                                                                                                                                                                                                                                              
C890300100PMAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; UNILATERAL                    MRI w/cont, breast,  uni    53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C890400100PMAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; UNILATERAL                 MRI w/o cont, breast, uni   53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C890500100PMAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST;  MRI w/o fol w/cont, brst, un53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C890500200QUNILATERAL                                                                                                                                                                                                                                                                                                           
C890600100PMAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; BILATERAL                     MRI w/cont, breast,  bi     53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C890700100PMAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; BILATERAL                  MRI w/o cont, breast, bi    53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C890800100PMAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST;  MRI w/o fol w/cont, breast, 53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C890800200QBILATERAL                                                                                                                                                                                                                                                                                                            
C890900100PMAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, CHEST (EXCLUDING MYOCARDIUM)      MRA w/cont, chest           53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C891000100PMAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, CHEST (EXCLUDING MYOCARDIUM)   MRA w/o cont, chest         53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C891100100PMAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,      MRA w/o fol w/cont, chest   53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C891100200QCHEST (EXCLUDING MYOCARDIUM)                                                                                                                                                                                                                                                                                         
C891200100PMAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, LOWER EXTREMITY                   MRA w/cont, lwr ext         53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C891300100PMAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, LOWER EXTREMITY                MRA w/o cont, lwr ext       53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C891400100PMAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,      MRA w/o fol w/cont, lwr ext 53      A                                          1833(t)(2)                                                 D                          I2D 4       2001100120011001        N                           
C891400200QLOWER EXTREMITY                                                                                                                                                                                                                                                                                                      
C891800100PMAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, PELVIS                            MRA w/cont, pelvis          53      A                                          430 BIPA                                                   D                          I2D 4       2003070120030701        N                           
C891900100PMAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, PELVIS                         MRA w/o cont, pelvis        53      A                                          430 BIPA                                                   D                          I2D 4       2003070120030701        N                           
C892000100PMAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,      MRA w/o fol w/cont, pelvis  53      A                                          430 BIPA                                                   D                          I2D 4       2003070120030701        N                           
C892000200QPELVIS                                                                                                                                                                                                                                                                                                               
C900000100PINJECTION, SODIUM CHROMATE CR51, PER 0.25 MCI                                   Na chromateCr51, per 0.25mCi53      A                                          1833(t)                           A9553                    D                      0093O1E 1       200010012006010120051231D                           
C900300100PPALIVIZUMAB-RSV-IGM, PER 50 MG                                                  Palivizumab, per 50 mg      53      A                                          1833(t)                                                    D                      0093O1E 1       2000100120001001        N                           
C900700100PBACLOFEN INTRATHECAL SCREENING KIT (1 AMP)                                      Baclofen Intrathecal kit-1am53      A                                          1833(t)                           J0476                    D                      0093O1E 1       200010012006010120051231D                           
C900800100PBACLOFEN INTRATHECAL REFILL KIT, PER 500 MCG                                    Baclofen Refill Kit-500mcg  53      A                                          1833(t)                           J0475                    D                      0093O1E 1       200010012006010120051231D                           
C900900100PBACLOFEN INTRATHECAL REFILL KIT, PER 2000 MCG                                   Baclofen Refill Kit-2000mcg 53      A                                          1833(t)                           J0475                    D                      0093O1E 1       200010012006010120051231D                           
C901000100PBACLOFEN INTRATHECAL REFILL KIT, PER 4000 MCG                                   Baclofen Refill Kit--4000mcg53      A                                          1833(T)                                                    D                      0093O1E 1       200010012004010120031231N                           
C901300100PSUPPLY OF CO 57 COBALTOUS CHLORIDE, RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENTCo 57 cobaltous chloride    53      A                                          1833(t)                                                    D                      0093O1E 1       200104012006010120051231D                           
C901900100PINJECTION, CASPOFUNGIN ACETATE, 5 MG                                            Caspofungin acetate, 5 mg   53      A                                          1833(T)                           J0637                    D                          O1E 1       200107012003010120021231N                           
C902000100PSIROLIMUS TABLET, 1 MG                                                          Sirolimus tablet, 1 mg      53      A                                          1833(T)                           J7520                    D                          O1E 1       200107012003010220020101N                           
C910000100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, IODINATED I-131         Iodinated I-131 Albumin     53      A                                          1833(t)                                                    D                      0093I1E 4       200010012003010120021231N                           
C910000200QALBUMIN, PER MCI                                                                                                                                                                                                                                                                                                     
C910200100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, 51 SODIUM CHROMATE, PER 51 Na Chromate, 50mCi       53      A                                          1833(t)                           A9553                    D                      0093I1E 4       200010012006010120051231D                           
C910200200Q50 MCI                                                                                                                                                                                                                                                                                                               
C910300100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM IOTHALAMATE      Na Iothalamate I-125, 10 uCi53      A                                          1833(t)                           A9554                    D                      0093I1E 4       200010012006010120051231D                           
C910300200QI-125 INJECTION, PER 10 UCI                                                                                                                                                                                                                                                                                          
C910500100PINJECTION, HEPATITIS B IMMUNE GLOBULIN, PER 1 ML                                Hep B imm glob, per 1 ml    53      A                                          1833(t)                           90371                    D                      0093O1E 1       200010012006010120051231D                           
C910800100PINJECTION, THYROTROPIN ALPHA, 1.1 MG                                            Thyrotropin alfa, 1.1 mg    53      A                                          1833(T)                           J3240                    D                          O1E 9       200101012003010120021231N                           
C910900100PINJECTION, TIROFIBAN HYDROCHLORIDE, 6.25 MG                                     Tirofiban hcl, 6.25 mg      53      A                                          1833(T)                           J3246                    D                          O1E 9       200101012005010120041231N                           
C911000100PINJECTION, ALEMTUZUMAB, PER 10 MG/ ML                                           Alemtuzumab, per 10mg/ml    53      A                                          1833(T)                           J9010                    D                          D1A 9S      200110012003010120021231N                           
C911100100PINJECTION, BIVALIRUDIN, 250 MG PER VIAL                                         Inj, bivalirudin, 250mg vial53      A                                          1833(t)                                                    D                          O1E 9       200201012004010120031231N                           
C911200100PINJECTION, PERFLUTREN LIPID MICROSPHERE, PER 2 ML VIAL                          Perflutren lipid micro, 2ml 53      A                                          1833(t)                           Q9957                    D                          I1E 9       200201012006010120051231D                           
C911300100PINJECTION, PANTOPRAZOLE SODIUM, PER VIAL                                        Inj pantoprazole sodium, via53      A                                          1833(T)                                                    D                          O1E 9       2002010120020101        N                           
C911400100PINJECTION, NESIRITIDE, PER 1.5 MG VIAL                                          Nesiritide, per 1.5 mg vial 53      A                                          1833(T)                           J2324                    D                          O1E 9       200201012003010120021231N                           
C911500100PINJECTION, ZOLEDRONIC ACID, PER 2 MG                                            Inj, zoledronic acid, 2 mg  53      A                                          1833(T)                           J3487                    D                          O1E 9       200201012003010120021231N                           
C911600100PINJECTION, ERTAPENEM SODIUM, PER 1 GRAM VIAL                                    Ertapenem sodium, per 1 gm  53      A                                          1833(t)                                                    D                      0093O1E 9       200210012004010120031231N                           
C911700100PINJECTION, YTTRIUM-90 IBRITUMOMAB TIUXETAN, PER MCI                             Y-90 ibritumomab tiuxetan   53      A                                          1833(t)                           A9523                    D                      0093O1E 9       200210012003010120021231N                           
C911800100PINJECTION, INDIUM-111 IBRITUMOMAB TIUXETAN, PER MCI                             IN-111 ibritumomab tiuxetan 53      A                                          1833(t)                           A9522                    D                      0093O1E 9       200210012003010120021231N                           
C911900100PINJECTION, PEGFILGRASTIM, PER 6 MG SINGLE DOSE VIAL                             Injection, pegfilgrastim    53      A                                          1833(t)                                                    D                      0093O1E 9       200210012003070120030630N                           
C912000100PINJECTION, FULVESTRANT, PER 50 MG                                               Injection, fulvestrant      53      A                                          1833(T)                                                    D                      0093O1E 1P      200301012004010120031231N                           
C912100100PINJECTION, ARGATROBAN, PER 5 MG                                                 Injection, argatroban       53      A                                          1833(T)                                                    D                      0093O1E 1P      2003010120030101        N                           
C912300100PHUMAN FIBROBLAST DERIVED TEMPORARY SKIN SUBSTITUTE, PER 247 SQUARE CENTIMETERS  Transcyte, per 247 sq cm    53      A                                          1833T                                                      D                      0093D1A 9S      200307012006010120051231D                           
C912400100PINJECTION, DAPTOMYCIN, PER 1 MG                                                 Injection, daptomycin       53      A                                          1833(T)                           J0878                    D                          O1E 1       200401012005010120041231N                           
C912500100PINJECTION, RISPERIDONE, PER 12.5 MG                                             Injection, risperidone      53      A                                          1833(T)                           J2794                    D                          O1E 1       200401012005010120041231N                           
C912600100PINJECTION, NATALIZUMAB, PER 5 MG                                                Injection, natalizumab      53      A                                          1833(T)                           Q4079                    D                      0093O1E 9       200411232005040120050331D                           
C912700100PINJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, PER 1 MG                         Paclitaxel protein pr       53      A                                          1833(T)                           J9264                    D                          O1D 1       200501072006010120051231D                           
C912800100PINJECTION, PEGAPTANIB SODIUM, PER 0.3 MG                                        Inj pegaptanib sodium       53      A                                          1833(T)                           J2503                    D                          O1E 9       200412172006010120051231D                           
C912900100PINJECTION, CLOFARABINE, PER 1 MG                                                Inj clofarabine             53      A                                          621MMA                            J9027                    D                          O1E 9       200507012006010120051231D                           
C920000100PBILAYERED CELLULAR MATRIX, PER 36 SQUARE CENTIMETERS                            Orcel, per 36 cm2           53      A                                          1833(T)                           J7340                    D                          D1A 9       200201012006010120051231D                           
C920100100PHUMAN FIBROBLAST-DERIVED DERMAL SUBSTITUTE, PER 37.5 SQUARE CENTIMETERS         Dermagraft, per 37.5 sq cm  53      A                                          1833(T)                           J7342                    D                          D1A 9       200201012006010120051231D                           
C920200100PINJECTION, SUSPENSION OF MICROSPHERES OF HUMAN SERUM ALBUMIN WITH               Octafluoropropane           53      A                                          1833T                             Q9956                    D                          I1E 9       200304012006010120051231D                           
C920200200QOCTAFLUOROPROPANE, PER 3 ML                                                                                                                                                                                                                                                                                          
C920300100PINJECTION, PERFLEXANE LIPID MICROSPHERES, PER 10 ML VIAL                        Perflexane lipid micro      53      A                                          1833T                             Q9955                    D                          I1E 9       200304012006010120051231D                           
C920400100PINJECTION, ZIPRASIDONE MESYLATE, PER 20 MG                                      Ziprasidone mesylate        53      A                                          1833T                                                      D                          O1E 9       200304012004010120031231N                           
C920500100PINJECTION, OXALIPLATIN, PER 5 MG                                                Oxaliplatin                 53      A                                          1833T                             J9263                    D                          O1D 9       200307012006010120051231D                           
C920600100PCOLLAGEN-GLYCOSAMINOGLYCAN BILAYER MATRIX, PER CM2                              Integra, per cm2            53      A                                          1833(T)                           J7343                    D                          D1A 9       200501012006010120051231D                           
C920700100PINJECTION, BORTEZOMIB, PER 3.5 MG                                               Injection, bortezomib       53      A                                          1833T                             J9041                    D                      0093O1E 9       200310012005010120041231N                           
C920800100PINJECTION, AGALSIDASE BETA, PER 1 MG                                            Injection, agalsidase beta  53      A                                          1833T                             J0180                    D                      0093O1E 9       200310012005010120041231N                           
C920900100PINJECTION, LARONIDASE, PER 2.9 MG                                               Injection, laronidase       53      A                                          1833T                             J1931                    D                      0093O1E 9       200310012005010120041231N                           
C921000100PINJECTION, PALONOSETRON HYDROCHLORIDE, PER 250 MCG                              Injection, palonosetron HCl 53      A                                          1833T                             J2469                    D                      0093O1E 9       200401012005010120041231N                           
C921100100PINJECTION, ALEFACEPT, FOR INTRAVENOUS USE, PER 7.5 MG                           Inj, alefacept, IV          53      A                                          1833T                             J0215                    D                      0093O1E 9       200401012006010120051231D                           
C921200100PINJECTION, ALEFACEPT, FOR INTRAMUSCULAR USE, PER 7.5 MG                         Inj, alefacept, IM          53      A                                          1833T                             J0215                    D                      0093O1E 9G      200401012006010120051231D                           
C921300100PINJECTION, PEMETREXED, PER 10 MG                                                Injection, pemetrexed       53      A                                          621MMA                            J9305                    D                          O1D 1       200402042005010120041231N                           
C921400100PINJECTION, BEVACIZUMAB, PER 10 MG                                               Injection, bevacizumab      53      A                                          621MMA                            J9035                    D                          O1D 1       200402262005010120041231N                           
C921500100PINJECTION, CETUXIMAB, PER 10 MG                                                 Injection, cetuximab        53      A                                          621MMA                            J9055                    D                          O1D 1       200402122005010120041231N                           
C921600100PINJECTION, ABARELIX FOR INJECTABLE SUSPENSION, PER 10 MG                        Abarelix, inject suspension 53      A                                          621MMA                            J0128                    D                          O1D 1       200401012005010120041231N                           
C921700100PINJECTION, OMALIZUMAB, PER 5 MG                                                 Injection, omalizumab       53      A                                          621MMA                            J2357                    D                          O1E 1       200401012005010120041231N                           
C921800100PINJECTION, AZACITIDINE, PER 1 MG                                                Injection, azacitidine      53      A                                          MMA-Sec621                        J9025                    D                          O1E 9       200405192006010120051231D                           
C921900100PMYCOPHENOLIC ACID, ORAL, PER 180 MG                                             Mycophenolic acid, oral     53      A                                          MMA-Sec621                        J7518                    D                          O1E 9G      200402272005010120041231N                           
C922000100PSODIUM HYALURONATE PER 30 MG DOSE, FOR INTRA-ARTICULAR INJECTION                Sodium hyaluronate          53      A                                          1833(t)                                                    D                          O1E 9       2005010120050101        N                           
C922100100PACELLULAR DERMAL TISSUE MATRIX, PER 16CM2                                       Graftjacket Reg Matrix      53      A                                          1833(t)                                                    D                          D1A 9       2005010120050101        N                           
C922200100PDECELLULARIZED SOFT TISSUE SCAFFOLD, PER 1 CC                                   Graftjacket SftTis          53      A                                          1833(t)                                                    D                          D1A 9       2005010120050101        N                           
C922300100PINJECTION, ADENOSINE FOR THERAPEUTIC OR DIAGNOSTIC USE, 6 MG (NOT TO BE USED TO Inj adenosine, tx dx        53      A                                          1833(T)                           J0150J0152               D                          O1E 1P      200504012006010120051231D                           
C922300200QREPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270)                                                                                                                                                                                                                                                         
C922400100PINJECTION, GALSULFASE, PER 5 MG                                                 Injection, galsulfase       51      A                                          621MMA                                                     D                          O1E 9       2005053120050531        A                           
C922500100PINJECTION, FLUOCINOLONE  ACETONIDE INTRAVITREAL IMPLANT, PER 0.59 MG            Fluocinolone acetonide      53      A                                          621MMA                                                     D                          O1E 9       2005100120051001        A                           
C922600100PINJECTION, ZICONOTIDE FOR INTRATHECAL INFUSION, PER 5 MCG                       Ziconotide intrathecal inf  53      A                                          621MMA                            J2278                    D                          D1G 9       200510012006010120051231D                           
C939900100PUNCLASSIFIED DRUGS OR BIOLOGICALS                                               Unclassified drugs or biolog53      A                                          621MMA                                                     D                          O1E 1       2004010120040101        N                           
C940000100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, THALLOUS CHLORIDE TL    Thallous chloride, brand    53      A                                          621 of MMA                        A9505                    D                          I1E 4       200401012006010120051231D                           
C940000200Q201, BRAND NAME, PER MCI                                                                                                                                                                                                                                                                                             
C940100100PSUPPLY OF THERAPEUTIC RADIOPHARMACEUTICAL, STRONTIUM-89 CHLORIDE, BRAND NAME,   Strontium-89 chloride,brand 53      A                                          621MMA                            A9600                    D                          I1E 6       200401012006010120051231D                           
C940100200QPER MCI                                                                                                                                                                                                                                                                                                              
C940200100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 SODIUM IODIDE    Th I131 so iodide cap, brand53      A                                          621 of MMA                        A9517                    D                          I1E 4       200401012006010120051231D                           
C940200200QCAPSULE, BRAND NAME, PER MCI                                                                                                                                                                                                                                                                                         
C940300100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC AGENT, I-131 SODIUM IODIDE CAPSULE,    Dx I131 so iodide cap, brand53      A                                          621 of MMA                        A9528                    D                          D1E 4       200401012006010120051231D                           
C940300200QBRAND NAME,  PER MILLICURIE                                                                                                                                                                                                                                                                                          
C940400100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC AGENT, I-131 SODIUM IODIDE SOLUTION,   Dx I131 so iodide sol, brand53      A                                          621 of MMA                        A9529                    D                          I1E 4       200401012006010120051231D                           
C940400200QBRAND NAME, PER MILLICURIE                                                                                                                                                                                                                                                                                           
C940500100PSUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC AGENT, I-131 SODIUM IODIDE SOLUTION,  Th I131 so iodide sol, brand53      A                                          621 of MMA                        A9530                    D                          I1E 4       200401012006010120051231D                           
C940500200QBRAND NAME, PER MILLICURIE                                                                                                                                                                                                                                                                                           
C941000100PINJECTION, DEXRAZOXANE HYDROCHLORIDE, BRAND NAME, PER 250 MG                    Dexrazoxane HCl inj, brand  53      A                                          621 of MMA                        J1190                    D                          O1E 1P      200401012006010120051231D                           
C941100100PINJECTION, PAMIDRONATE DISODIUM, BRAND NAME, PER 30 MG                          Pamidronate disodium, brand 53      A                                          621 of MMA                        J2430                    D                          O1E 1P      200401012006010120051231D                           
C941200100PGANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT, BRAND NAME                            Ganciclovir implant, brand  53      A                                          621 of MMA                        J7310                    D                          O1E 9       200401012005010120041231N                           
C941300100PSODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR INJECTION, BRAND   Sodium hyaluronate inj, bran53      A                                          621 of MMA                        J7317                    D                          O1E 1       200401012006010120051231D                           
C941300200QNAME                                                                                                                                                                                                                                                                                                                 
C941400100PETOPOSIDE, ORAL, BRAND NAME, 50 MG                                              Etoposide oral, brand       53      A                                          621 of MMA                        J8560                    D                          O1D 1       200401012006010120051231D                           
C941500100PDOXORUBICIN HCL, BRAND NAME, 10 MG                                              Doxorubic hcl chemo, brand  53      A                                          621 of MMA                        J9000                    D                          O1D 1       200401012006010120051231D                           
C941700100PBLEOMYCIN SULFATE, BRAND NAME, 15 UNITS                                         Bleomycin sulfate inj, brand53      A                                          621 of MMA                        J9040                    D                          O1D 1       200401012006010120051231D                           
C941800100PCISPLATIN, POWDER OR S0LUTION, BRAND NAME, PER 10 MG                            Cisplatin inj, brand        53      A                                          621 of MMA                        J9060                    D                          O1D 1       200401012006010120051231D                           
C941900100PINJECTION, CLADRIBINE, BRAND NAME, PER 1 MG                                     Inj cladribine, brand       53      A                                          621 of MMA                        J9065                    D                          O1D 1       200401012006010120051231D                           
C942000100PCYCLOPHOSPHAMIDE, BRAND NAME, 100 MG                                            Cyclophosphamide inj, brand 53      A                                          621 of MMA                        J9070                    D                          O1D 1       200401012006010120051231D                           
C942100100PCYCLOPHOSPHAMIDE, LYOPHILIZED, BRAND NAME, 100 MG                               Cyclophosphamide lyo, brand 53      A                                          621 of MMA                        J9093                    D                          O1D 1       200401012006010120051231D                           
C942200100PCYTARABINE, BRAND NAME, 100 MG                                                  Cytarabine hcl inj, brand   53      A                                          621 of MMA                        J9100                    D                          O1D 1       200401012006010120051231D                           
C942300100PDACARBAZINE, BRAND NAME, 100 MG                                                 Dacarbazine inj, brand      53      A                                          621 of MMA                        J9130                    D                          O1D 1       200401012006010120051231D                           
C942400100PDAUNORUBICIN, BRAND NAME, 10 MG                                                 Daunorubicin, brand         53      A                                          621 of MMA                        J9150                    D                          O1D 1       200401012006010120051231D                           
C942500100PETOPOSIDE, BRAND NAME, 10 MG                                                    Etoposide inj, brand        53      A                                          621 of MMA                        J9181                    D                          O1D 1       200401012006010120051231D                           
C942600100PFLOXURIDINE, BRAND NAME, 500 MG                                                 Floxuridine inj, brand      53      A                                          621 of MMA                        J9200                    D                          O1D 1       200401012006010120051231D                           
C942700100PIFOSFAMIDE, BRAND NAME, 1 GM                                                    Ifosfamide inj, brand       53      A                                          621 of MMA                        J9208                    D                          O1D 1       200401012006010120051231D                           
C942800100PMESNA, BRAND NAME, 200 MG                                                       Mesna injection, brand      53      A                                          621 of MMA                        J9209                    D                          O1D 1       200401012006010120051231D                           
C942900100PIDARUBICIN HYDROCHLORIDE, BRAND NAME, 5 MG                                      Idarubicin hcl inj, brand   53      A                                          621 of MMA                        J9211                    D                          O1D 1       200401012006010120051231D                           
C943000100PLEUPROLIDE ACETATE, BRAND NAME, PER 1 MG                                        Leuprolide acetate inj, bran53      A                                          621 of MMA                        J9218                    D                          O1D 1       200401012006010120051231D                           
C943100100PPACLITAXEL, BRAND NAME, 30 MG                                                   Paclitaxel inj, brand       53      A                                          621 of MMA                        J9265                    D                          O1D 1       200401012006010120051231D                           
C943200100PMITOMYCIN, BRAND NAME, 5 MG                                                     Mitomycin inj, brand        53      A                                          621 of MMA                        J9280                    D                          O1D 1       200401012006010120051231D                           
C943300100PTHIOTEPA, BRAND NAME, 15 MG                                                     Thiotepa inj, brand         53      A                                          621 of MMA                        J9340                    D                          O1D 1       200401012006010120051231D                           
C943500100PINJECTION, GONADORELIN HYDROCHLORIDE, BRAND NAME, PER 100 MCG                   Gonadorelin hydroch, brand  53      A                                          1833(t)                           J1620                    D                          O1E 9       200501012006010120051231D                           
C943600100PAZATHIOPRINE, PARENTERAL, BRAND NAME, PER 100 MG                                Azathioprine parenteral,brnd53      A                                          1833(t)                           J7501                    D                          O1E 9       200501012006010120051231D                           
C943700100PCARMUSTINE, BRAND NAME, 100 MG                                                  Carmus bischl nitro inj     53      A                                          1833(t)                           J9050                    D                          O1D 9       200501012006010120051231D                           
C943800100PCYCLOSPORINE, ORAL, BRAND NAME, 100 MG                                          Cyclosporine oral, brand    53      A                                          621 of MMA                        J7502                    D                          O1E 1G      200401012006010120051231D                           
C943900100PDIETHYLSTILBESTROL DIPHOSPHATE, BRAND NAME, 250 MG                              Diethylstilbestrol injection53      A                                          1833(t)                           J9165                    D                          O1D 9       200501012006010120051231D                           
C944000100PVINORELBINE TARTRATE, BRAND NAME, PER 10 MG                                     Vinorelbine tar,brand       53      A                                          1833(T)                           J9390                    D                          O1D 9       200501012006010120051231D                           
C950300100PFRESH FROZEN PLASMA, DONOR RETESTED, EACH UNIT                                  Fresh frozen plasma, ea unit53      A                                          1833(t)                                                    D                      0093T1H 9       200010012004010120031231N                           
C970100100PSTRETTA SYSTEM                                                                  Stretta System              53      A                                          1833(T)                                                    D                      0093P8B 9S      200101012005010120041231N                           
C970300100PBARD ENDOSCOPIC SUTURING SYSTEM                                                 Bard Endoscopic Suturing Sys53      A                                          1833(T)                                                    D                          P8B 9       200201012005010120041231N                           
C970400100PINJECTION OR INSERTION OF INERT SUBSTANCE FOR SUBMUCOSAL/INTRAMUSCULAR          Inj inert subs upper GI     53      A                                          1833T                             0133T                    D                          P5E 2       200401012006010120051231D                           
C970400200QINJECTION(S) INTO THE UPPER GASTROINTESTINAL TRACT, UNDER FLUOROSCOPIC GUIDANCE                                                                                                                                                                                                                                      
C970800100PPREVIEW TREATMENT PLANNING SOFTWARE                                             Preview Tx Planning Software53      A                                          1833(T)                                                    D                          I2B 4       200107012003010120021231N                           
C971100100PH.E.L.P. APHERESIS SYSTEM                                                       H.E.L.P. Apheresis System   53      A                                          1833(T)                                                    D                          D1A 9       200110012004010120031231N                           
C971200100PINSERTION OF A PH CAPSULE FOR MEASUREMENT AND MONITORING OF GASTROESOPHAGEAL    Insert pH capsule, GERD     53      A                                          1833(T)                           91035                    D                          T2D 1       200404012005010120041231N                           
C971200200QREFLUX DISEASE, INCLUDES DATA COLLECTION AND INTERPRETATION                                                                                                                                                                                                                                                          
C971300100PNON-CONTACT LASER VAPORIZATION OF PROSTATE, INCLUDING COAGULATION CONTROL OF    Non-contact laser vap prosta53      A                                          1833(T)                           52648                    D                          P1D 2       200404012006010120051231D                           
C971300200QINTRAOPERATIVE AND POST-OPERATIVE BLEEDING                                                                                                                                                                                                                                                                           
C971400100PPLACEMENT OF BALLOON CATHETER INTO THE BREAST FOR INTERSTITIAL RADIATION        Breast inters rad tx, immed 53      A                                          1833(T)                           19297                    D                          P7A 6       200404012005010120041231N                           
C971400200QTHERAPY FOLLOWING A PARTIAL MASTECTOMY; CONCURRENT/IMMEDIATE (ADD-ON)                                                                                                                                                                                                                                                
C971500100PPLACEMENT OF BALLOON CATHETER INTO THE BREAST FOR INTERSTITIAL RADIATION        Breast inters rad tx, delay 53      A                                          1833(T)                           19296                    D                          P7A 6       200404012005010120041231N                           
C971500200QTHERAPY FOLLOWING A PARTIAL MASTECTOMY; DELAYED                                                                                                                                                                                                                                                                      
C971600100PCREATIONS OF THERMAL ANAL LESIONS BY RADIOFREQUENCY ENERGY                      Radiofrequency energy to anu53      A                                          1833T                                                      D                          P6D 2       2004070120040701        N                           
C971700100PHEMORRHOIDOPEXY, COMPLEX OR EXTENSIVE, BY A CIRCULAR STAPLER                    Stapled hemorrhoidopexy     53      A                                          1833T                             46947                    D                          P5E 2       200410012005010120041231N                           
C971800100PKYPHOPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION              Kyphoplasty, first vertebra 53      A                                          1833(t)                           22523                    D                          P5B 1       200501012006010120051231D                           
C971900100PKYPHOPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; EACH        Kyphoplasty, each addl      53      A                                          1833(t)                           22525                    D                          P5B 1       200501012006010120051231D                           
C971900200QADDITIONAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY                                                                                                                                                                                                                                           
C971900300QPROCEDURE)                                                                                                                                                                                                                                                                                                           
C972000100PHIGH-ENERGY (GREATER THAN 0.22MJ/MM2) EXTRACORPOREAL SHOCK WAVE (ESW) TREATMENT HE ESW tx, tennis elbow     53      A                                          1833(t)                           0102T                    D                          P5B 1       200501012006010120051231D                           
C972000200QFOR CHRONIC LATERAL EPICONDYLITIS (TENNIS ELBOW)                                                                                                                                                                                                                                                                     
C972100100PHIGH-ENERGY (GREATER THAN 0.22MJ/MM2) EXTRACORPOREAL SHOCK WAVE (ESW) TREATMENT HE ESW tx, plantar fasciitis53      A                                          1833(t)                           28890                    D                          P5B 1       200501012006010120051231D                           
C972100200QFOR CHRONIC PLANTAR FASCIITIS                                                                                                                                                                                                                                                                                        
C972200100PSTEREOSCOPIC KV X-RAY IMAGING WITH INFRARED TRACKING FOR LOCALIZATION OF TARGET KV imaging w/IR tracking    53      A                                          1833(t)                           77421                    D                          I4B 4       200501012006010120051231D                           
C972200200QVOLUME (DO NOT REPORT C9722 IN CONJUNCTION WITH G0173, G0243, G0251, G0339 OR                                                                                                                                                                                                                                        
C972200300QG0340)                                                                                                                                                                                                                                                                                                               
C972300100PDYNAMIC INFRARED BLOOD PERFUSION IMAGING (DIRI)                                 Dyn IR Perf Img             53      A                                          1833(T)                                                    D                      0093I4B 4       2005040120050401        A                           
C972400100PENDOSCOPIC FULL-THICKNESS PLICATION IN THE GASTRIC CARDIA USING ENDOSCOPIC      EPS gast cardia plic        53      A                                          1833(T)                                                    D                          P8I 2       2005040120050401        A                           
C972400200QPLICATION SYSTEM (EPS); INCLUDES ENDOSCOPY                                                                                                                                                                                                                                                                           
C972500100PPLACEMENT OF ENDORECTAL INTRACAVITARY APPLICATOR FOR HIGH INTENSITY             Place endorectal app        53      A                                          1833(T)                                                    D                          P7A 6       2005100120051001        A                           
C972500200QBRACHYTHERAPY                                                                                                                                                                                                                                                                                                        
D012000100PPERIODIC ORAL EVALUATION                                                        Periodic oral evaluation    00      9                                          1862A(12)                                                  S                      0059Y1  1       1982010119970101        N                           
D014000100PLIMITED ORAL EVALUATION - PROBLEM FOCUSED                                       Limit oral eval problm focus00      9                                          1862A(12)                                                  S                          Y1  1       1996010119960101        N                           
D015000100PCOMPREHENSIVE ORAL EVALUATION - NEW OR ESTABLISHED PATIENT                      Comprehensve oral evaluation13      A50-26             2136    2336                                                                       D                          Y1  1       1996010120030101        N                           
D016000100PDETAILED AND EXTENSIVE ORAL EVALUATION - PROBLEM FOCUSED, BY REPORT             Extensv oral eval prob focus00      9                                          1862A(12)                                                  S                          Y1  1       1996010119960101        N                           
D017000100PRE-EVALUATION-LIMITED, PROBLEM FOCUSED (ESTABLISHED PATIENT; NOT POST-OPERATIVE Re-eval,est pt,problem focus00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D017000200QVISIT)                                                                                                                                                                                                                                                                                                               
D018000100PCOMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT               Comp periodontal evaluation 00      9                                          1862a(12)                                                  S                          Y1  1       2003010120030101        N                           
D021000100PINTRAORAL-COMPLETE SERIES (INCLUDING BITEWINGS)                                 Intraor complete film series00      9                                                                            70320                    I                          Y1  4       1982010119960101        N                           
D022000100PINTRAORAL-PERIAPICAL-FIRST FILM                                                 Intraoral periapical first f00      9                                                                            70300                    I                          Y1  4       1984010119960101        N                           
D023000100PINTRAORAL-PERIAPICAL-EACH ADDITIONAL FILM                                       Intraoral periapical ea add 00      9                                                                            70310                    I                          Y1  4       1984010119960101        N                           
D024000100PINTRAORAL-0CCLUSAL FILM                                                         Intraoral occlusal film     13      A                  2136    2336                                                                       D                          Y1  4       1984010119930101        N                           
D025000100PEXTRAORAL-FIRST FILM                                                            Extraoral first film        13      A                  2136    2336                                                                       D                          Y1  4       1984010119930101        N                           
D026000100PEXTRAORAL-EACH ADDITIONAL FILM                                                  Extraoral ea additional film13      A                  2136    2336                                                                       D                          Y1  4       1982010119930101        N                           
D027000100PBITEWING-SINGLE FILM                                                            Dental bitewing single film 13      A                  2136    2336                                                                       D                          Y1  4       1982010119930101        N                           
D027200100PBITEWINGS-TWO FILMS                                                             Dental bitewings two films  13      A                  2136    2336                                                                       D                          Y1  4       1982010119930101        N                           
D027400100PBITEWINGS-FOUR FILMS                                                            Dental bitewings four films 13      A                  2136    2336                                                                       D                          Y1  4       1982010119930101        N                           
D027700100PVERTICAL BITEWINGS - 7 TO 8 FILMS                                               Vert bitewings-sev to eight 13      A                  2136    2336                                                                       D                          Y1  4       2000010120000101        N                           
D029000100PPOSTERIOR-ANTERIOR OR LATERAL SKULL AND FACIAL BONE SURVEY FILM                 Dental film skull/facial bon00      9                                                                            70150                    I                          Y1  4       1982010119960101        N                           
D031000100PSIALOGRAPHY                                                                     Dental saliography          00      9                                                                            70390                    I                          Y1  4       1986010119960101        N                           
D032000100PTEMPOROMANDIBULAR JOINT ARTHROGRAM, INCLUDING INJECTION                         Dental tmj arthrogram incl i00      9                                                                            70332                    I                          Y1  4       1986010119960101        N                           
D032100100POTHER TEMPOROMANDIBULAR JOINT FILMS, BY REPORT                                  Dental other tmj films      00      9                                                                            76499                    I                          Y1  4       1984010119960101        N                           
D032200100PTOMOGRAPHIC SURVEY                                                              Dental tomographic survey   00      950-26                                                                       CPT                      I                          Y1  4       1992010119960101        N                           
D033000100PPANORAMIC FILM                                                                  Dental panoramic film       00      9                                                                            70320                    I                          Y1  4       1984010119960101        N                           
D034000100PCEPHALOMETRIC FILM                                                              Dental cephalometric film   00      9                                                                            70350                    I                          Y1  4       1982010119960101        N                           
D035000100PORAL/FACIAL PHOTOGRAPHIC IMAGES                                                 Oral/facial photo images    00      9                                                                                                     I                      0090Y1  4       2000010120050101        N                           
D041500100PCOLLECTION OF MICROORGANISMS FOR CULTURE AND SENSITIVITY                        Collection of microorganisms00      9                                          1862 A(12)                        D0410                    S                      0059Y1  5       1992010120050101        N                           
D041600100PVIRAL CULTURE                                                                   Viral culture               00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D042100100PGENETIC TEST FOR SUSCEPTIBILITY TO ORAL DISEASES                                Gen tst suscept oral disease00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D042500100PCARIES SUSCEPTIBILITY TESTS                                                     Caries susceptibility test  00      9                                          1862 A(12)                        D0420                    S                      0059Y1  5       1992010119970101        N                           
D043100100PADJUNCTIVE PRE-DIAGNOSTIC TEST THAT AIDS IN DETECTION OF MUCOSAL ABNORMALITIES  Diag tst detect mucos abnorm00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D043100200QINCLUDING PREMALIGNANT AND MALIGNANT LESIONS, NOT TO INCLUDE CYTOLOGY OR BIOPSY                                                                                                                                                                                                                                      
D043100300QPROCEDURES                                                                                                                                                                                                                                                                                                           
D046000100PPULP VITALITY TESTS                                                             Pulp vitality test          13      A50-26             2136    2336                                                                       D                          Y1  5       1982010119930101        N                           
D047000100PDIAGNOSTIC CASTS                                                                Diagnostic casts            00      9                                          1862 a(12)                                                 S                          Y1  5       1982010119960101        N                           
D047200100PACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN Gross exam, prep & report   13      A50-26             2136    2336                                                                       D                          Y1  5       2000010120000101        N                           
D047200200QREPORT                                                                                                                                                                                                                                                                                                               
D047300100PACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, PREPARATION AND         Micro exam, prep & report   13      A50-26             2136    2336                                                                       D                          Y1  5       2000010120000101        N                           
D047300200QTRANSMISSION OF WRITTEN REPORT                                                                                                                                                                                                                                                                                       
D047400100PACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, INCLUDING ASSESSMENT OF Micro w exam of surg margins13      A50-26             2136    2336                                                                       D                          Y1  5       2000010120000101        N                           
D047400200QSURGICAL MARGINS FOR PRESENCE OF DISEASE, PREPARATION AND TRANSMISSION OF                                                                                                                                                                                                                                            
D047400300QWRITTEN REPORT                                                                                                                                                                                                                                                                                                       
D047500100PDECALCIFICATION PROCEDURE                                                       Decalcification procedure   00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D047600100PSPECIAL STAINS FOR MICROORGANISMS                                               Spec stains for microorganis00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D047700100PSPECIAL STAINS, NOT FOR MICROORGANISMS                                          Spec stains not for microorg00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D047800100PIMMUNOHISTOCHEMICAL STAINS                                                      Immunohistochemical stains  00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D047900100PTISSUE IN-SITU HYBRIDIZATION, INCLUDING INTERPRETATION                          Tissue in-situ hybridization00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D048000100PPROCESSING AND INTERPRETATION OF EXFOLIATIVE CYTOLOGIC SMEARS, INCLUDING THE    Cytopath smear prep & report13      A50-26             2136    2336                                                                       D                          Y1  5       2000010120050101        N                           
D048000200QPREPARATION AND TRANSMISSION OF WRITTEN REPORT                                                                                                                                                                                                                                                                       
D048100100PELECTRON MICROSCOPY - DIAGNOSTIC                                                Electron microscopy diagnost00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D048200100PDIRECT IMMUNOFLUORESCENCE                                                       Direct immunofluorescence   00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D048300100PINDIRECT IMMUNOFLUORESCENCE                                                     Indirect immunofluorescence 00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D048400100PCONSULTATION ON SLIDES PREPARED ELSEWHERE                                       Consult slides prep elsewher00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D048500100PCONSULTATION, INCLUDING PREPARATION OF SLIDES FROM BIOPSY MATERIAL SUPPLIED BY  Consult inc prep of slides  00      9                                                                                                     C                          Y1  5       2005010120050101        N                           
D048500200QREFERRING SOURCE                                                                                                                                                                                                                                                                                                     
D050100100PHISTOPATHOLOGIC EXAMINATIONS                                                    Histopathologic examinations13      A50-26             2136    2336                                                                       D                          Y1  5       198601012003010120021231N                           
D050200100POTHER ORAL PATHOLOGY PROCEDURES, BY REPORT                                      Other oral pathology procedu13      A50-26             2136    2336                                                                       D                          Y1  5       1986010119930101        N                           
D099900100PUNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT                                     Unspecified diagnostic proce13      A50-26             2136    2336                                                                       D                          Y1  5       1984010119930101        N                           
D111000100PPROPHYLAXIS-ADULT                                                               Dental prophylaxis adult    00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D112000100PPROPHYLAXIS-CHILD                                                               Dental prophylaxis child    00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D120100100PTOPICAL APPLICATION OF FLUORIDE (INCLUDING PROPHYLAXIS)-CHILD                   Topical fluor w prophy child00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D120300100PTOPICAL APPLICATION OF FLUORIDE (PROPHYLAXIS NOT INCLUDED)-CHILD                Topical fluor w/o prophy chi00      9                                          1862 a(12)                                                 S                          Y1  1       1986010119960101        N                           
D120400100PTOPICAL APPLICATION OF FLUORIDE (PROPHYLAXIS NOT INCLUDED)-ADULT                Topical fluor w/o prophy adu00      9                                          1862 a(12)                                                 S                          Y1  1       1986010119960101        N                           
D120500100PTOPICAL APPLICATION OF FLUORIDE (INCLUDING PROPHYLAXIS)-ADULT                   Topical fluoride w/ prophy a00      9                                          1862 a(12)                        D1202                    S                          Y1  1       1992010119960101        N                           
D131000100PNUTRITIONAL COUNSELING FOR THE CONTROL OF DENTAL DISEASE                        Nutri counsel-control caries00      9                  2300                                                                               M                          Y1  1       1982010119960101        N                           
D132000100PTOBACCO COUNSELING FOR THE CONTROL AND PREVENTION OF ORAL DISEASE               Tobacco counseling          00      9                  2300                                                                               M                          Y1  1       1996010119960101        N                           
D133000100PORAL HYGIENE INSTRUCTION                                                        Oral hygiene instruction    00      9                  2300                                                                               M                          Y1  1       1982010119960101        N                           
D135100100PSEALANT-PER TOOTH                                                               Dental sealant per tooth    00      9                                          1862 a(12)                                                 S                          Y1  1       1985010119960101        N                           
D151000100PSPACE MAINTAINER-FIXED UNILATERAL                                               Space maintainer fxd unilat 13      A                  2336                                                                               D                          Y1  9       1984010119930101        N                           
D151500100PSPACE MAINTAINER-FIXED BILATERAL                                                Fixed bilat space maintainer13      A                  2336    2136                                                                       D                          Y1  9       1984010119930101        N                           
D152000100PSPACE MAINTAINER-REMOVABLE UNILATERAL                                           Remove unilat space maintain13      A                  2336    2136                                                                       D                          Y1  9       1984010119930101        N                           
D152500100PSPACE MAINTAINER-REMOVABLE BILATERAL                                            Remove bilat space maintain 13      A                  2336    2136                                                                       D                          Y1  9       1984010119930101        N                           
D155000100PRECEMENTATION OF SPACE MAINTAINER                                               Recement space maintainer   13      A                  2336    2136                                                                       D                          Y1  1       1982010119930101        N                           
D211000100PAMALGAM-ONE SURFACE, PRIMARY                                                    Amalgam one surface primary 00      9                                          1862 a(12)                                                 S                          Y1  1       198501012003010120021231N                           
D212000100PAMALGAM-TWO SURFACES, PRIMARY                                                   Amalgam two surfaces primary00      9                                          1862 a(12)                                                 S                          Y1  1       198501012003010120021231N                           
D213000100PAMALGAM-THREE SURFACES, PRIMARY                                                 Amalgam three surfaces prima00      9                                          1862 a(12)                                                 S                          Y1  1       198501012003010120021231N                           
D213100100PAMALGAM-FOUR OR MORE SURFACES, PRIMARY                                          Amalgam four/more surf prima00      9                                          1862 a(12)                                                 S                          Y1  1       198501012003010120021231N                           
D214000100PAMALGAM-ONE SURFACE, PRIMARY OR PERMANENT                                       Amalgam one surface permanen00      9                                          1862 a(12)                                                 S                          Y1  1       1982010120030101        N                           
D215000100PAMALGAM-TWO SURFACES, PRIMARY OR PERMANENT                                      Amalgam two surfaces permane00      9                                          1862 a(12)                                                 S                          Y1  1       1982010120030101        N                           
D216000100PAMALGAM-THREE SURFACES, PRIMARY OR PERMANENT                                    Amalgam three surfaces perma00      9                                          1862 a(12)                                                 S                          Y1  1       1982010120030101        N                           
D216100100PAMALGAM-FOUR OR MORE SURFACES, PRIMARY OR PERMANENT                             Amalgam 4 or > surfaces perm00      9                                          1862 a(12)                                                 S                          Y1  1       1982010120030101        N                           
D233000100PRESIN-ONE SURFACE, ANTERIOR                                                     Resin one surface-anterior  00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D233100100PRESIN-TWO SURFACES, ANTERIOR                                                    Resin two surfaces-anterior 00      9                                          1861 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D233200100PRESIN-THREE SURFACES, ANTERIOR                                                  Resin three surfaces-anterio00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D233500100PRESIN-FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)               Resin 4/> surf or w incis an00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D233600100PCOMPOSITE RESIN CROWN-ANTERIOR-PRIMARY                                          Composite resin crown       00      9                                          1862 a(12)                                                 S                          Y1  1       199201012003010120021231N                           
D233700100PRESIN-BASED COMPOSITE CROWN, ANTERIOR-PERMANENT                                 Compo resin crown ant-perm  00      9                                          1862a(12)                                                  S                          Y1  1       200001012003010120021231N                           
D238000100PRESIN-ONE SURFACE, POSTERIOR-PRIMARY                                            Resin one surf poster primar00      9                                          1862 a(12)                                                 S                          Y1  1       199201012003010120021231N                           
D238100100PRESIN-TWO SURFACES, POSTERIOR-PRIMARY                                           Resin two surf poster primar00      9                                          1862 a(12)                                                 S                          Y1  1       199201012003010120021231N                           
D238200100PRESIN-THREE OR MORE SURFACES, POSTERIOR-PRIMARY                                 Resin three/more surf post p00      9                                          1862 a(12)                                                 S                          Y1  1       199201012003010120021231N                           
D238500100PRESIN-ONE SURFACE, POSTERIOR-PERMANENT                                          Resin one surf poster perman00      9                                          1862 a(12)                                                 S                      0060Y1  1       199201012003010120021231N                           
D238600100PRESIN-TWO SURFACES, POSTERIOR-PERMANENT                                         Resin two surf poster perman00      9                                          1862 a(12)                                                 S                          Y1  1       199201012003010120021231N                           
D238700100PRESIN-THREE OR MORE SURFACES, POSTERIOR-PERMANENT                               Resin three/more surf post p00      9                                          1862 a(12)                                                 S                          Y1  1       199201012003010120021231N                           
D238800100PRESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR PERMANENT              Resin four/more, post perm  00      9                                          1862a(12)                                                  S                          Y1  1       200001012003010120021231N                           
D239000100PRESIN-BASED COMPOSITE CROWN, ANTERIOR                                           Ant resin-based cmpst crown 00      9                                          1862a(12)                                                  S                          Y1  1       2003010120030101        N                           
D239100100PRESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR                                  Post 1 srfc resinbased cmpst00      9                                          1862a(12)                                                  S                          Y1  1       2003010120030101        N                           
D239200100PRESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR                                 Post 2 srfc resinbased cmpst00      9                                          1862a(12)                                                  S                          Y1  1       2003010120030101        N                           
D239300100PRESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR                               Post 3 srfc resinbased cmpst00      9                                          1862a(12)                                                  S                          Y1  1       2003010120030101        N                           
D239400100PRESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR                        Post >=4srfc resinbase cmpst00      9                                          1862a(12)                                                  S                          Y1  1       2003010120030101        N                           
D241000100PGOLD FOIL-ONE SURFACE                                                           Dental gold foil one surface00      9                                          1862 a(12)                                                 S                          Y1  1       1982010119960101        N                           
D242000100PGOLD FOIL-TWO SURFACES                                                          Dental gold foil two surface00      9                                          1862 a(12)                                                 S                          Y1  1       1982010119960101        N                           
D243000100PGOLD FOIL-THREE SURFACES                                                        Dental gold foil three surfa00      9                                          1862 a(12)                                                 S                          Y1  1       1982010119960101        N                           
D251000100PINLAY-METALLIC-ONE SURFACE                                                      Dental inlay metalic 1 surf 00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D252000100PINLAY-METALLIC-TWO SURFACES                                                     Dental inlay metallic 2 surf00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D253000100PINLAY-METALLIC-THREE OR MORE SURFACES                                           Dental inlay metl 3/more sur00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D254200100PONLAY-METALLIC-TWO SURFACES                                                     Dental onlay metallic 2 surf00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D254300100PONLAY - METALLIC - THREE SURFACES                                               Dental onlay metallic 3 surf00      9                                          1862 a(12)                                                 S                          Y1  1       1996010119960101        N                           
D254400100PONLAY - METALLIC - FOUR OR MORE SURFACES                                        Dental onlay metl 4/more sur00      9                                          1862 a(12)                                                 S                          Y1  1       1996010119960101        N                           
D261000100PINLAY-PORCELAIN/CERAMIC-ONE SURFACE                                             Inlay porcelain/ceramic 1 su00      9                                          1862 a(12)                                                 S                          Y1  1       1984010119960101        N                           
D262000100PINLAY-PORCELAIN/CERAMIC-TWO SURFACES                                            Inlay porcelain/ceramic 2 su00      9                                          1862 a(12)                                                 S                          Y1  1       1986010119960101        N                           
D263000100PINLAY-PORCELAIN/CERAMIC-THREE OR MORE SURFACES                                  Dental onlay porc 3/more sur00      9                                          1862 a(12)                                                 S                          Y1  1       1986010119960101        N                           
D264200100PONLAY - PORCELAIN/CERAMIC - TWO SURFACES                                        Dental onlay porcelin 2 surf00      9                                          1862 a(12)                                                 S                          Y1  1       1996010119960101        N                           
D264300100PONLAY - PORCELAIN/CERAMIC - THREE SURFACES                                      Dental onlay porcelin 3 surf00      9                                          1862 a(12)                                                 S                          Y1  1       1996010119960101        N                           
D264400100PONLAY - PORCELAIN/CERAMIC - FOUR OR MORE SURFACES                               Dental onlay porc 4/more sur00      9                                          1862 a(12)                                                 S                          Y1  1       1996010119960101        N                           
D265000100PINLAY - RESIN-BASED COMPOSITE - ONE SURFACE                                     Inlay composite/resin one su00      9                                          1862 a(12)                                                 S                          Y1  1       1992010120000101        N                           
D265100100PINLAY - RESIN-BASED COMPOSITE - TWO SURFACES                                    Inlay composite/resin two su00      9                                          1862 a(12)                                                 S                          Y1  1       1992010120000101        N                           
D265200100PINLAY - RESIN-BASED COMPOSITE - THREE OR MORE SURFACES                          Dental inlay resin 3/mre sur00      9                                          1862 a(12)                                                 S                          Y1  1       1992010120000101        N                           
D266200100PONLAY - RESIN-BASED COMPOSITE - TWO SURFACES                                    Dental onlay resin 2 surface00      9                                          1862 a(12)                                                 S                          Y1  1       1996010120000101        N                           
D266300100PONLAY - RESIN-BASED COMPOSITE - THREE SURFACES                                  Dental onlay resin 3 surface00      9                                          1862 a(12)                                                 S                          Y1  1       1996010120000101        N                           
D266400100PONLAY - - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES                         Dental onlay resin 4/mre sur00      9                                          1862 a(12)                                                 S                          Y1  1       1996010120000101        N                           
D271000100PCROWN - RESIN-BASED COMPOSITE (INDIRECT)                                        Crown resin-based indirect  00      9                                          1862a(12)                                                  S                          Y1  1       1984010120050101        N                           
D271200100PCROWN - 3/4 RESIN-BASED COMPOSITE (INDIRECT)                                    Crown 3/4 resin-based compos00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D272000100PCROWN-RESIN WITH HIGH NOBLE METAL                                               Crown resin w/ high noble me00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D272100100PCROWN-RESIN WITH PREDOMINANTLY BASE METAL                                       Crown resin w/ base metal   00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D272200100PCROWN-RESIN WITH NOBLE METAL                                                    Crown resin w/ noble metal  00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D274000100PCROWN-PORCELAIN/CERAMIC SUBSTRATE                                               Crown porcelain/ceramic subs00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D275000100PCROWN-PORCELAIN FUSED TO HIGH NOBLE METAL                                       Crown porcelain w/ h noble m00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D275100100PCROWN-PROCELAIN FUSED TO PREDOMINANTLY BASE METAL                               Crown porcelain fused base m00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D275200100PCROWN-PORCELAIN FUSED TO NOBLE METAL                                            Crown porcelain w/ noble met00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D278000100PCROWN - 3/4 CAST HIGH NOBLE METAL                                               Crown 3/4 cast hi noble met 00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D278100100PCROWN - 3/4 CAST PREDOMINANTLY BASE METAL                                       Crown 3/4 cast base metal   00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D278200100PCROWN - 3/4 CAST NOBLE METAL                                                    Crown 3/4 cast noble metal  00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D278300100PCROWN - 3/4 PORCELAIN/CERAMIC                                                   Crown 3/4 porcelain/ceramic 00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D279000100PCROWN-FULL CAST HIGH NOBLE METAL                                                Crown full cast high noble m00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D279100100PCROWN-FULL CAST PREDOMINANTLY BASE METAL                                        Crown full cast base metal  00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D279200100PCROWN-FULL CAST NOBLE METAL                                                     Crown full cast noble metal 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D279400100PCROWN-TITANIUM                                                                  Crown-titanium              00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D279900100PPROVISIONAL CROWN                                                               Provisional crown           00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D291000100PRECEMENT INLAY, ONLAY OR PARTIAL COVERAGE RESTORATION                           Recement inlay onlay or part00      9                                          1862a(12)                                                  S                          Y1  1       1984010120050101        N                           
D291500100PRECEMENT CAST OR PREFABRICATED POST AND CORE                                    Recement cast or prefab post00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D292000100PRECEMENT CROWN                                                                  Dental recement crown       00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D293000100PPREFABRICATED STAINLESS STEEL CROWN-PRIMARY TOOTH                               Prefab stnlss steel crwn pri00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D293100100PPREFABRICATED STAINLESS STEEL CROWN-PERMANENT TOOTH                             Prefab stnlss steel crown pe00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D293200100PPREFABRICATED RESIN CROWN                                                       Prefabricated resin crown   00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D293300100PPREFABRICATED STAINLESS STEEL CROWN WITH RESIN WINDOW                           Prefab stainless steel crown00      9                                          1862a(12)                                                  S                          Y1  1       1992010119960101        N                           
D293400100PPREFABRICATED ESTHETIC COATED STAINLESS STEEL CROWN - PRIMARY TOOTH             Prefab steel crown primary  00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D294000100PSEDATIVE FILLING                                                                Dental sedative filling     00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D295000100PCORE BUILD-UP, INCLUDING ANY PINS                                               Core build-up incl any pins 00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D295100100PPIN RETENTION-PER TOOTH, IN ADDITION TO RESTORATION                             Tooth pin retention         00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D295200100PCAST POST AND CORE IN ADDITION TO CROWN                                         Post and core cast + crown  00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D295300100PEACH ADDITIONAL CAST POST  - SAME TOOTH                                         Each addtnl cast post       00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D295400100PPREFABRICATED POST AND CORE IN ADDITION TO CROWN                                Prefab post/core + crown    00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D295500100PPOST REMOVAL (NOT IN CONJUCTION WITH ENDODONTIC THERAPY)                        Post removal                00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D295700100PEACH ADDITIONAL PREFABRICATED  POST - SAME TOOTH                                Each addtnl prefab post     00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D296000100PLABIAL VENEER (LAMINATE)-CHAIRSIDE                                              Laminate labial veneer      00      9                                          1862a(12)                                                  S                          Y1  1       1985010119960101        N                           
D296100100PLABIAL VENEER (RESIN LAMINATE)-LABORATORY                                       Lab labial veneer resin     00      9                                          1862a(12)                                                  S                          Y1  1       1992010119960101        N                           
D296200100PLABIAL VENEER (PORCELAIN LAMINATE)-LABORATORY                                   Lab labial veneer porcelain 00      9                                          1862a(12)                                                  S                          Y1  1       1992010119960101        N                           
D297000100PTEMPORARY (FRACTURED TOOTH)                                                     Temporary- fractured tooth  13      A                  2136    2336                                                                       D                          Y1  1       198601012005010120041231N                           
D297100100PADDITIONAL PROCEDURES TO CONSTRUCT NEW CROWN UNDER EXISTING PARTIAL DENTURE     Add proc construct new crown00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D297100200QFRAMEWORK                                                                                                                                                                                                                                                                                                            
D297500100PCOPING                                                                          Coping                      00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D298000100PCROWN REPAIR, BY REPORT                                                         Crown repair                00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D299900100PUNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT                                    Dental unspec restorative pr13      A                  2336    2136                                                                       D                          Y1  1       1986010119930101        N                           
D311000100PPULP CAP-DIRECT (EXCLUDING FINAL RESTORATION)                                   Pulp cap direct             00      9                                          1862a(12)                                                  S                          Y1  1       1982010119960101        N                           
D312000100PPULP CAP-INDIRECT  (EXCLUDING FINAL RESTORATION)                                Pulp cap indirect           00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D322000100PTHERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION)  REMOVAL OF PULP CORONAL TO Therapeutic pulpotomy       00      9                                          1862a(12)                                                  S                          Y1  2       1984010120000101        N                           
D322000200QTHE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT                                                                                                                                                                                                                                                           
D322100100PPULPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH                                 Gross pulpal debridement    00      9                                          1862a(12)                                                  S                          Y1  2       2000010120030101        N                           
D323000100PPULPAL THERAPY (RESORBABLE FILLING)-ANTERIOR, PRIMARY TOOTH (EXCLUDING FINAL    Pulpal therapy anterior prim00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D323000200QRESTORATION)                                                                                                                                                                                                                                                                                                         
D324000100PPULPAL THERAPY (RESORBABLE FILLING)-POSTERIOR, PRIMARY TOOTH (EXCLUDING FINAL   Pulpal therapy posterior pri00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D324000200QRESTORATION)                                                                                                                                                                                                                                                                                                         
D331000100PANTERIOR (EXCLUDING FINAL RESTORATION)                                          Anterior                    00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D332000100PBICUSPID (EXCLUDING FINAL RESTORATION)                                          Root canal therapy 2 canals 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D333000100PMOLAR (EXCLUDING FINAL RESTORATION)                                             Root canal therapy 3 canals 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D333100100PTREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS                        Non-surg tx root canal obs  00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D333200100PINCOMPLETE ENDODONTIC THERAPY; INOPERABLE, UNRESTORABLE OR FRACTURED TOOTH      Incomplete endodontic tx    00      9                                          1862a(12)                                                  S                          Y1  1       2000010120050101        N                           
D333300100PINTERNAL ROOT REPAIR OF PERFORATION DEFECTS                                     Internal root repair        00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D334600100PRETREATMENT OF PREVIOUS ROOT CANAL THERAPY-ANTERIOR                             Retreat root canal anterior 00      9                                          1862a(12)                                                  S                          Y1  1       1992010119960101        N                           
D334700100PRETREATMENT OF PREVIOUS ROOT CANAL THERAPY-BICUSPID                             Retreat root canal bicuspid 00      9                                          1862a(12)                                                  S                          Y1  1       1992010119960101        N                           
D334800100PRETREATMENT OF PREVIOUS ROOT CANAL THERAPY-MOLAR                                Retreat root canal molar    00      9                                          1862a(12)                                                  S                          Y1  1       1992010119960101        N                           
D335100100PAPEXIFICATION/RECALCIFICATION-INITIAL VISIT (APICAL CLOSURE/CALCIFIC REPAIR OF  Apexification/recalc initial00      9                                          1862a(12)                                                  S                          Y1  2       1992010119960101        N                           
D335100200QPERFORATIONS, ROOT RESORPTION, ETC.)                                                                                                                                                                                                                                                                                 
D335200100PAPEXIFICATION/RECALCIFICATION-INTERIM MEDICATION REPLACEMENT (APICAL            Apexification/recalc interim00      9                                          1862a(12)                                                  S                          Y1  2       1992010119960101        N                           
D335200200QCLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)                                                                                                                                                                                                                                                      
D335300100PAPEXIFICATION/RECALCIFICATION-FINAL VISIT (INCLUDES COMPLETED ROOT CANAL        Apexification/recalc final  00      9                                          1862a(12)                                                  S                          Y1  2       1992010119960101        N                           
D335300200QTHERAPY-APICAL CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)                                                                                                                                                                                                                                       
D341000100PAPICOECTOMY/PERIRADICULAR SURGERY-ANTERIOR                                      Apicoect/perirad surg anter 00      9                                          1862a(12)                                                  S                          Y1  2       1984010119960101        N                           
D342100100PAPICOECTOMY/PERIRADICULAR SURGERY-BICUSPID (FIRST ROOT)                         Root surgery bicuspid       00      9                                          1862a(12)                                                  S                          Y1  2       1992010119960101        N                           
D342500100PAPICOECTOMY/PERIRADICULAR SURGERY-MOLAR (FIRST ROOT).                           Root surgery molar          00      9                                          1862a(12)                                                  S                          Y1  2       1992010119960101        N                           
D342600100PAPICOECTOMY/PERIRADICULAR SURGERY (EACH ADDITIONAL ROOT)                        Root surgery ea add root    00      9                                          1862a(12)                                                  S                          Y1  2       1992010119960101        N                           
D343000100PRETROGRADE FILLING-PER ROOT                                                     Retrograde filling          00      9                                          1862a(12)                                                  S                          Y1  2       1984010119960101        N                           
D345000100PROOT AMPUTATION-PER ROOT                                                        Root amputation             00      9                                          1862a(12)                                                  S                          Y1  2       1984010119960101        N                           
D346000100PENDODONTIC ENDOSSEOUS IMPLANT                                                   Endodontic endosseous implan13      A                  2336    2136                                                                       D                          Y1  2       1984010119930101        N                           
D347000100PINTENTIONAL REPLANTATION (INCLUDING NECESSARY SPLINTING)                        Intentional replantation    00      9                                          1862a(12)                                                  S                          Y1  2       1992010119960101        N                           
D391000100PSURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM                       Isolation- tooth w rubb dam 00      9                                          1862a(12)                                                  S                          Y1  2       1982010119960101        N                           
D392000100PHEMISECTION (INCLUDING ANY ROOT REMOVAL), NOT INCLUDING ROOT CANAL THERAPY      Tooth splitting             00      9                                          1862a(12)                                                  S                          Y1  2       1984010119960101        N                           
D395000100PCANAL PREPARATION AND FITTING OF PREFORMED DOWEL OR POST                        Canal prep/fitting of dowel 00      9                                          1862a(12)                                                  S                          Y1  1       1982010119960101        N                           
D399900100PUNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT                                     Endodontic procedure        13      A                  2336    2136                                                                       D                          Y1  1       1984010119930101        N                           
D421000100PGINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH  Gingivectomy/plasty per quad00      9                                                                            41820                    I                          Y1  2       1985010120050101        N                           
D421000200QSPACES PER QUADRANT                                                                                                                                                                                                                                                                                                  
D421100100PGINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE CONTIGUOUS TEETH OR BOUNDED TEETH  Gingivectomy/plasty per toot00      9                                                                            CPT                      I                      0019Y1  2       1986010120050101        N                           
D421100200QSPACES PER QUADRANT                                                                                                                                                                                                                                                                                                  
D422000100PGINGIVAL CURETTAGE, SURGICAL, PER QUADRANT, BY REPORT                           Gingival curettage per quadr00      9                                          1862a(12)                                                  S                          Y1  2       198401012003010120021231N                           
D424000100PGINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH Gingival flap proc w/ planin00      9                                          1862a(12)                                                  S                          Y1  2       1984010120050101        N                           
D424000200QOR BOUNDED TEETH SPACES PER QUADRANT                                                                                                                                                                                                                                                                                 
D424100100PGINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE CONTIGUOUS TEETH Gngvl flap w rootplan 1-3 th00      9                                          1862a(12)                                                  S                          Y1  2       2003010120050101        N                           
D424100200QOR BOUNDED TEETH SPACES PER QUADRANT                                                                                                                                                                                                                                                                                 
D424500100PAPICALLY POSITIONED FLAP                                                        Apically positioned flap    00      9                                          1862a(12)                                                  S                          Y1  2       2000010120000101        N                           
D424900100PCLINICAL CROWN LENGTHENING-HARD TISSUE                                          Crown lengthen hard tissue  00      9                                          1862a(12)                                                  S                          Y1  2       1992010119960101        N                           
D426000100POSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - FOUR OR MORE CONTIGUOUS    Osseous surgery per quadrant13      A                  2136    2336                                                                       D                          Y1  2       1985010120050101        N                           
D426000200QTEETH OR BOUNDED TEETH SPACES PER QUADRANT                                                                                                                                                                                                                                                                           
D426100100POSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - ONE TO THREE CONTIGUOUS    Osseous surgl-3teethperquad 00      9                                          1862a(12)                                                  S                          Y1  2       2003010120050101        N                           
D426100200QTEETH OR BOUNDED TEETH SPACES PER QUADRANT                                                                                                                                                                                                                                                                           
D426300100PBONE REPLACEMENT GRAFT - FIRST SITE IN QUADRANT                                 Bone replce graft first site13      A50-26             2336    2136                                                                       D                          Y1  2       1996010119960101        N                           
D426400100PBONE REPLACEMENT GRAFT - EACH ADDITIONAL SITE IN QUADRANT                       Bone replce graft each add  13      A50-26             2336    2136                                                                       D                          Y1  2       1996010119960101        N                           
D426500100PBIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION               Bio mtrls to aid soft/os reg00      9                                          1862a(12)                                                  S                          Y1  2       2003010120030101        N                           
D426600100PGUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER SITE                       Guided tiss regen resorble  00      9                                          1862a(12)                                                  S                          Y1  2       1996010120000101        N                           
D426700100PGUIDED TISSUE REGENERATION - NONRESORBABLE BARRIER, PER SITE, (INCLUDES         Guided tiss regen nonresorb 00      9                                          1862a(12)                                                  S                          Y1  2       1996010120000101        N                           
D426700200QMEMBRANE REMOVAL)                                                                                                                                                                                                                                                                                                    
D426800100PSURGICAL REVISION PROCEDURE, PER TOOTH                                          Surgical revision procedure 00      9                  2136    2336                                                                       D                          Y1  2       2000010120000101        N                           
D427000100PPEDICLE SOFT TISSUE GRAFT PROCEDURE                                             Pedicle soft tissue graft pr13      A                  2336    2136                                                                       D                          Y1  2       1984010119930101        N                           
D427100100PFREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING DONOR SITE SURGERY)                 Free soft tissue graft proc 13      A                  2336    2136                                                                       D                          Y1  2       1984010119960101        N                           
D427300100PSUBEPITHELIAL CONNECTIVE TISSUE GRAFT PROCEDURES, PER TOOTH                     Subepithelial tissue graft  13      A50-26             2136    2336                                                                       D                          Y1  2       1996010120050101        N                           
D427400100PDISTAL OR PROXIMAL WEDGE PROCEDURE (WHEN NOT PERFORMED IN CONJUCTION WITH       Distal/proximal wedge proc  00      9                                          1862a(12)                                                  S                          Y1  2       1996010119960101        N                           
D427400200QSURGICAL PROCEDURES IN THE SAME ANATOMICAL AREA)                                                                                                                                                                                                                                                                     
D427500100PSOFT TISSUE ALLOGRAFT                                                           Soft tissue allograft       00      9                                          1862a(12)                                                  S                          Y1  2       2003010120030101        N                           
D427600100PCOMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT, PER TOOTH                  Con tissue w dble ped graft 00      9                                          1862a(12)                                                  S                          Y1  2       2003010120050101        N                           
D432000100PPROVISIONAL SPLINTING-INTRACORONAL                                              Provision splnt intracoronal00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D432100100PPROVISIONAL SPLINTING-EXTRACORONAL                                              Provisional splint extracoro00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D434100100PPERIODONTAL SCALING AND ROOT PLANING - FOUR OR MORE TEETH PER QUADRANT          Periodontal scaling & root  00      9                                          1862a(12)                                                  S                          Y1  1       1985010120050101        N                           
D434200100PPERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT         Periodontal scaling 1-3teeth00      9                                          1862a(12)                                                  S                          Y1  1       2003010120030101        N                           
D435500100PFULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS         Full mouth debridement      13      A50-26             2136    2336                                                                       D                          Y1  1       1996010120030101        N                           
D438100100PLOCALIZED DELIVERY OF ANTIMICROBIAL AGENTS VIA A CONTROLLED RELEASE VEHICLE     Localized delivery antimicro13      A50-26             2136    2336                                                                       D                          Y1  1       1996010120050101        N                           
D438100200QINTO DISEASED CREVICULAR TISSUE, PER TOOTH, BY REPORT                                                                                                                                                                                                                                                                
D491000100PPERIODONTAL MAINTENANCE                                                         Periodontal maint procedures00      9                                          1862a(12)                                                  S                          Y1  1       1984010120030101        N                           
D492000100PUNSCHEDULED DRESSING CHANGE (BY SOMEONE OTHER THAN TREATING DENTIST)            Unscheduled dressing change 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D499900100PUNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT                                    Unspecified periodontal proc00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D511000100PCOMPLETE DENTURE - MAXILLARY                                                    Dentures complete maxillary 00      9                                          1862a(12)                                                  S                          Y1  9       1982010119960101        N                           
D512000100PCOMPLETE DENTURE - MANDIBULAR                                                   Dentures complete mandible  00      9                                          1862a(12)                                                  S                          Y1  9       1982010119960101        N                           
D513000100PIMMEDIATE DENTURE - MAXILLARY                                                   Dentures immediat maxillary 00      9                                          1862a(12)                                                  S                          Y1  9       1982010119960101        N                           
D514000100PIMMEDIATE DENTURE - MANDIBULAR                                                  Dentures immediat mandible  00      9                                          1862a(12)                                                  S                          Y1  9       1982010119960101        N                           
D521100100PUPPER PARTIAL-RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)   Dentures maxill part resin  00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D521200100PLOWER PARTIAL-RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)   Dentures mand part resin    00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D521300100PMAXILLARY PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES       Dentures maxill part metal  00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D521300200Q(INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)                                                                                                                                                                                                                                                                 
D521400100PMANDIBULAR PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES      Dentures mandibl part metal 00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D521400200Q(INCLUDING ANY CONVENTIONAL CLASPS,RESTS AND TEETH)                                                                                                                                                                                                                                                                  
D522500100PMAXILLARY PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND      Maxillary part denture flex 00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D522500200QTEETH)                                                                                                                                                                                                                                                                                                               
D522600100PMANDIBULAR PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND     Mandibular part denture flex00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D522600200QTEETH)                                                                                                                                                                                                                                                                                                               
D528100100PREMOVABLE UNILATERAL PARTIAL DENTURE-ONE PIECE CAST METAL (INCLUDING CLASPS AND Removable partial denture   00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D528100200QTEETH)                                                                                                                                                                                                                                                                                                               
D541000100PADJUST COMPLETE DENTURE - MAXILLARY                                             Dentures adjust cmplt maxil 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D541100100PADJUST COMPLETE DENTURE - MANDIBULAR                                            Dentures adjust cmplt mand  00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D542100100PADJUST PARTIAL DENTURE - MAXILLARY                                              Dentures adjust part maxill 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D542200100PADJUST PARTIAL DENTURE - MANDIBULAR                                             Dentures adjust part mandbl 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D551000100PREPAIR BROKEN COMPLETE DENTURE BASE                                             Dentur repr broken compl bas00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D552000100PREPLACE MISSING OR BROKEN TEETH-COMPLETE DENTURE (EACH TOOTH)                   Replace denture teeth complt00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D561000100PREPAIR RESIN DENTURE BASE                                                       Dentures repair resin base  00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D562000100PREPAIR CAST FRAMEWORK                                                           Rep part denture cast frame 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D563000100PREPAIR OR REPLACE BROKEN CLASP                                                  Rep partial denture clasp   00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D564000100PREPLACE BROKEN TEETH-PER TOOTH                                                  Replace part denture teeth  00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D565000100PADD TOOTH TO EXISTING PARTIAL DENTURE                                           Add tooth to partial denture00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D566000100PADD CLASP TO EXISTING PARTIAL DENTURE                                           Add clasp to partial denture00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D567000100PREPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY)               Replc tth&acrlc on mtl frmwk00      9                                          1862a(12)                                                  S                          Y1  1       2003010120030101        N                           
D567100100PREPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR)              Replc tth&acrlc mandibular  00      9                                          1862a(12)                                                  S                          Y1  1       2003010120030101        N                           
D571000100PREBASE COMPLETE MAXILLARY DENTURE                                               Dentures rebase cmplt maxil 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D571100100PREBASE COMPLETE MANDIBULAR DENTURE                                              Dentures rebase cmplt mand  00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D572000100PREBASE MAXILLARY PARTIAL DENTURE                                                Dentures rebase part maxill 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D572100100PREBASE MANDIBULAR PARTIAL DENTURE                                               Dentures rebase part mandbl 00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D573000100PRELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)                                   Denture reln cmplt maxil ch 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D573100100PRELINE LOWER COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)                            Denture reln cmplt mand chr 00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D574000100PRELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)                                    Denture reln part maxil chr 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D574100100PRELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)                                   Denture reln part mand chr  00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D575000100PRELINE COMPLETE MAXILLARY DENTURE (LABORATORY)                                  Denture reln cmplt max lab  00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D575100100PRELINE COMPLETE MANDIBULAR DENTURE (LABORATORY)                                 Denture reln cmplt mand lab 00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D576000100PRELINE MAXILLARY PARTIAL DENTURE (LABORATORY)                                   Denture reln part maxil lab 00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D576100100PRELINE MANDIBULAR PARTIAL DENTURE (LABORATORY)                                  Denture reln part mand lab  00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D581000100PINTERIM COMPLETE DENTURE (MAXILLARY)                                            Denture interm cmplt maxill 00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D581100100PINTERIM COMPLETE DENTURE (MANDIBULAR)                                           Denture interm cmplt mandbl 00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D582000100PINTERIM PARTIAL DENTURE (MAXILLARY)                                             Denture interm part maxill  00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D582100100PINTERIM PARTIAL DENTURE (MANDIBULAR)                                            Denture interm part mandbl  00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D585000100PTISSUE CONDITIONING, MAXILLARY                                                  Denture tiss conditn maxill 00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D585100100PTISSUE CONDITIONING, MANDIBULAR                                                 Denture tiss condtin mandbl 00      9                                          1862a(12)                                                  S                          Y1  9       1992010119960101        N                           
D586000100POVERDENTURE-COMPLETE, BY REPORT                                                 Overdenture complete        00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D586100100POVERDENTURE-PARTIAL, BY REPORT                                                  Overdenture partial         00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D586200100PPRECISION ATTACHMENT, BY REPORT                                                 Precision attachment        00      9                                          1862a(12)                                                  S                          Y1  9       1986010119960101        N                           
D586700100PREPLACEMENT OF REPLACEABLE PART OF SEMI-PRECISION OR PRECISION ATTACHMENT (MALE Replacement of precision att00      9                                          1862a(12)                                                  S                          Y1  9       2000010120000101        N                           
D586700200QOR FEMALE COMPONENT)                                                                                                                                                                                                                                                                                                 
D587500100PMODIFICATION OF REMOVABLE PROSTHESIS FOLLOWING IMPLANT SURGERY                  Prosthesis modification     00      9                                          1862a(12)                                                  S                          Y1  9       2000010120000101        N                           
D589900100PUNSPECIFIED REMOVABLE PROSTHODONTIC PROCEDURE, BY REPORT                        Removable prosthodontic proc00      9                                          1862a(12)                                                  S                          Y1  9       1986010119960101        N                           
D591100100PFACIAL MOULAGE (SECTIONAL)                                                      Facial moulage sectional    13      A                  2130 A  2136                                                                       D                          Y1  9       1985010119930101        N                           
D591200100PFACIAL MOULAGE (COMPLETE)                                                       Facial moulage complete     13      A                  2130 A                                                                             D                          Y1  9       1985010119930101        N                           
D591300100PNASAL PROSTHESIS                                                                Nasal prosthesis            00      9                                                                            21087                    I                          Y1  9       1985010119960101        N                           
D591400100PAURICULAR PROSTHESIS                                                            Auricular prosthesis        00      9                                                                            21086                    I                          Y1  9       1985010119960101        N                           
D591500100PORBITAL PROSTHESIS                                                              Orbital prosthesis          00      9                                                                            L8611                    I                          Y1  9       1985010119960101        N                           
D591600100POCULAR PROSTHESIS                                                               Ocular prosthesis           00      9                                                                             CPT V2623V2629          I                          Y1  9       1985010119960101        N                           
D591900100PFACIAL PROSTHESIS                                                               Facial prosthesis           00      9                                                                            21088                    I                          Y1  9       1985010119960101        N                           
D592200100PNASAL SEPTAL PROSTHESIS                                                         Nasal septal prosthesis     00      9                                                                            30220                    I                          Y1  9       1992010119960101        N                           
D592300100POCULAR PROSTHESIS, INTERIM                                                      Ocular prosthesis interim   00      9                                                                            92330                    I                          Y1  9       1992010119960101        N                           
D592400100PCRANIAL PROSTHESIS                                                              Cranial prosthesis          00      9                                                                            62143                    I                          Y1  9       1992010119960101        N                           
D592500100PFACIAL AUGMENTATION IMPLANT PROSTHESIS                                          Facial augmentation implant 00      9                                                                            21208                    I                          Y1  9       1992010119960101        N                           
D592600100PNASAL PROSTHESIS, REPLACEMENT                                                   Replacement nasal prosthesis00      9                                                                            21087                    I                          Y1  9       1992010119960101        N                           
D592700100PAURICULAR PROSTHESIS, REPLACEMENT                                               Auricular replacement       00      9                                                                            21086                    I                          Y1  9       1992010119960101        N                           
D592800100PORBITAL PROSTHESIS, REPLACEMENT                                                 Orbital replacement         00      9                                                                            67550                    I                          Y1  9       1992010119960101        N                           
D592900100PFACIAL PROSTHESIS, REPLACEMENT                                                  Facial replacement          00      9                                                                            21088                    I                          Y1  9       1992010119960101        N                           
D593100100POBTURATOR PROSTHESIS, SURGICAL                                                  Surgical obturator          00      9                                                                            21079                    I                          Y1  9       1985010119960101        N                           
D593200100POBTURATOR PROSTHESIS, DEFINITIVE                                                Postsurgical obturator      00      9                                                                            21080                    I                          Y1  9       1985010119960101        N                           
D593300100POBTURATOR PROSTHESIS, MODIFICATION                                              Refitting of obturator      00      9                                                                            21080                    I                          Y1  9       1985010119960101        N                           
D593400100PMANDIBULAR RESECTION PROSTHESIS WITH GUIDE FLANGE                               Mandibular flange prosthesis00      9                                                                            21081                    I                          Y1  9       1985010119960101        N                           
D593500100PMANDIBULAR RESECTION PROSTHESIS WITHOUT GUIDE FLANGE                            Mandibular denture prosth   00      9                                                                            21081                    I                          Y1  9       1985010119960101        N                           
D593600100POBTURATOR/PROSTHESIS, INTERIM                                                   Temp obturator prosthesis   00      9                                                                            21079                    I                          Y1  9       1992010119960101        N                           
D593700100PTRISMUS APPLIANCE (NOT FOR TM TREATMENT)                                        Trismus appliance           00      9                  2130                                                                               I                          Y1  9       1992010119960101        N                           
D595100100PFEEDING AID                                                                     Feeding aid                 13      A                  2336    2130                                                                       D                          Y1  9       1985010119930101        N                           
D595200100PSPEECH AID PROSTHESIS, PEDIATRIC                                                Pediatric speech aid        00      9                                                                            21084                    I                          Y1  9       1985010119960101        N                           
D595300100PSPEECH AID PROSTHESIS, ADULT                                                    Adult speech aid            00      9                                                                            21084                    I                          Y1  9       1985010119960101        N                           
D595400100PPALATAL AUGMENTATION PROSTHESIS                                                 Superimposed prosthesis     00      9                                                                            21082                    I                          Y1  9       1985010119960101        N                           
D595500100PPALATAL LIFT PROSTHESIS, DEFINITIVE                                             Palatal lift prosthesis     00      9                                                                            21083                    I                          Y1  9       1985010119960101        N                           
D595800100PPALATAL LIFT PROSTHESIS, INTERIM                                                Intraoral con def inter plt 00      9                                                                            21083                    I                          Y1  9       1992010119960101        N                           
D595900100PPALATAL LIFT PROSTHESIS, MODIFICATION                                           Intraoral con def mod palat 00      9                                                                            21083                    I                          Y1  9       1992010119960101        N                           
D596000100PSPEECH AID PROSTHESIS, MODIFICATION                                             Modify speech aid prosthesis00      9                                                                            21084                    I                          Y1  9       1992010119960101        N                           
D598200100PSURGICAL STENT                                                                  Surgical stent              00      9                                                                            21085                    I                          Y1  9       1985010119960101        N                           
D598300100PRADIATION CARRIER                                                               Radiation applicator        13      A                  2336    2136                                                                       D                          Y1  9       1985010119930101        N                           
D598400100PRADIATION SHIELD                                                                Radiation shield            13      A                  2336    2136                                                                       D                          Y1  9       1985010119930101        N                           
D598500100PRADIATION CONE LOCATOR                                                          Radiation cone locator      13      A                  2336    2136                                                                       D                          Y1  9       1985010119930101        N                           
D598600100PFLUORIDE GEL CARRIER                                                            Fluoride applicator         00      9                                          1862a(12)                                                  S                          Y1  9       1985010119960101        N                           
D598700100PCOMMISSURE SPLINT                                                               Commissure splint           13      A                  2136    2336                                                                       D                          Y1  9       1992010119960101        N                           
D598800100PSURGICAL SPLINT                                                                 Surgical splint             13      A                                                                             CPT                     I                          Y1  9       1992010119960101        N                           
D599900100PUNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT                                 Maxillofacial prosthesis    00      9                                                                            CPT                      I                          Y1  9       1986010119960101        N                           
D601000100PSURGICAL PLACEMENT OF IMPLANT BODY:  ENDOSTEAL IMPLANT                          Odontics endosteal implant  00      9                                                                            21248                    I                          Y1  2       1996010119960101        N                           
D602000100PABUTMENT PLACEMENT OR SUBSTITUTION:  ENDOSTEAL IMPLANT                          Odontics abutment placement 00      9                                                                            21248                    I                          Y1  2       199601012005010120041231N                           
D604000100PSURGICAL PLACEMENT:  EPOSTEAL IMPLANT                                           Odontics eposteal implant   00      9                                                                            21245                    I                          Y1  2       1992010119960101        N                           
D605000100PSURGICAL PLACEMENT:  TRANSOSTEAL IMPLANT                                        Odontics transosteal implnt 00      9                                                                            21244                    I                          Y1  2       1992010119960101        N                           
D605300100PIMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR COMPLETELY EDENTULOUS ARCH     Implnt/abtmnt spprt remv dnt00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D605400100PIMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH      Implnt/abtmnt spprt remvprtl00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D605500100PDENTAL IMPLANT SUPPORTED CONNECTING BAR                                         Implant connecting bar      00      9                  2136                                                                               I                          Y1  9       1992010119960101        N                           
D605600100PPREFABRICATED ABUTMENT - INCLUDES PLACEMENT                                     Prefabricated abutment      00      9                  2136                                                                               M                          Y1  9       2000010120050101        N                           
D605700100PCUSTOM ABUTMENT - INCLUDES PLACEMENT                                            Custom abutment             00      9                  2136                                                                               M                          Y1  9       2000010120050101        N                           
D605800100PABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN                                      Abutment supported crown    00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D605900100PABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (HIGH NOBLE METAL)            Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606000100PABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (PREDOMINANTLY BASE METAL)    Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606100100PABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (NOBLE METAL)                 Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606200100PABUTMENT SUPPORTED CAST METAL CROWN (HIGH NOBLE METAL)                          Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606300100PABUTMENT SUPPORTED CAST METAL CROWN (PREDOMINANTLY BASE METAL)                  Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606400100PABUTMENT SUPPORTED CAST METAL CROWN (NOBLE METAL)                               Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606500100PIMPLANT SUPPORTED PORCELAIN/CERAMIC CROWN                                       Implant supported crown     00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606600100PIMPLANT SUPPORTED PORCELAIN FUSED TO METAL CROWN (TITANIUM, TITANIUM ALLOY,     Implant supported mtl crown 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606600200QHIGH NOBLE METAL)                                                                                                                                                                                                                                                                                                    
D606700100PIMPLANT SUPPORTED METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH NOBLE METAL)      Implant supported mtl crown 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606800100PABUTMENT SUPPORTED RETAINER FOR PORCELAIN/CERAMIC FPD                           Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D606900100PABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (HIGH NOBLE METAL) Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607000100PABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (PREDOMINANTLY     Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607000200QBASE METAL)                                                                                                                                                                                                                                                                                                          
D607100100PABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (NOBLE METAL)      Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607200100PABUTMENT SUPPORTED RETAINER FOR CAST  METAL FPD (HIGH NOBLE METAL)              Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607300100PABUTMENT SUPPORTED RETAINER FOR CAST  METAL FPD (PREDOMINANTLY BASE METAL)      Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607400100PABUTMENT SUPPORTED RETAINER FOR CAST  METAL FPD (NOBLE METAL)                   Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607500100PIMPLANT SUPPORTED RETAINER FOR CERAMIC FPD                                      Implant supported retainer  00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607600100PIMPLANT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (TITANIUM, TITANIUM Implant supported retainer  00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607600200QALLOY, OR HIGH NOBLE METAL)                                                                                                                                                                                                                                                                                          
D607700100PIMPLANT SUPPORTED RETAINER FOR CAST METAL FPD (TITANIUM, TITANIUM ALLOY, OR     Implant supported retainer  00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607700200QHIGH NOBLE METAL)                                                                                                                                                                                                                                                                                                    
D607800100PIMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR COMPLETELY EDENTULOUS ARCH         Implnt/abut suprtd fixd dent00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D607900100PIMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH          Implnt/abut suprtd fixd dent00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D608000100PIMPLANT MAINTENANCE PROCEDURES, INCLUDING: REMOVAL OF PROSTHESIS, CLEANSING OF  Implant maintenance         00      9                  2136                                                                               I                          Y1  2       1992010119960101        N                           
D608000200QPROSTHESIS AND ABUTMEN REINSERTION OF PROSTHESIS                                                                                                                                                                                                                                                                     
D609000100PREPAIR IMPLANTSUPPORTED PROSTHESIS BY REPORT                                    Repair implant              00      9                                                                            21299                    I                          Y1  9       1992010119960101        N                           
D609400100PABUTMENT SUPPORTED CROWN - (TITANIUM)                                           Abut support crown titanium 00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D609500100PREPAIR IMPLANT ABUTMENT, BY REPORT                                              Odontics repr abutment      00      9                                                                            21299                    I                          Y1  9       1996010119960101        N                           
D610000100PIMPLANT REMOVAL, BY REPORT                                                      Removal of implant          00      9                                                                            21299                    I                          Y1  9       1992010119960101        N                           
D619000100PRADIOGRAPHIC/SURGICAL IMPLANT INDEX, BY REPORT                                  Radio/surgical implant index00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D619400100PABUTMENT SUPPORTED RETAINER CROWN FOR FPD - (TITANIUM)                          Abut support retainer titani00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D619900100PUNSPECIFIED IMPLANT PROCEDURE, BY REPORT                                        Implant procedure           00      9                                                                            21299                    I                          Y1  9       1992010119960101        N                           
D620500100PPONTIC - INDIRECT RESIN BASED COMPOSITE                                         Pontic-indirect resin based 00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D621000100PPONTIC-CAST HIGH NOBLE METAL                                                    Prosthodont high noble metal00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D621100100PPONTIC-CAST PREDOMINANTLY BASE METAL                                            Bridge base metal cast      00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D621200100PPONTIC-CAST NOBLE METAL                                                         Bridge noble metal cast     00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D621400100PPONTIC - TITANIUM                                                               Pontic titanium             00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D624000100PPONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL                                      Bridge porcelain high noble 00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D624100100PPONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL                              Bridge porcelain base metal 00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D624200100PPONTIC-PORCELAIN FUSED TO NOBLE METAL                                           Bridge porcelain nobel metal00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D624500100PPONTIC - PORCELAIN/CERAMIC                                                      Bridge porcelain/ceramic    00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D625000100PPONTIC-RESIN WITH HIGH NOBLE METAL                                              Bridge resin w/high noble   00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D625100100PPONTIC-RESIN WITH PREDOMINANTLY BASE METAL                                      Bridge resin base metal     00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D625200100PPONTIC-RESIN WITH NOBLE METAL                                                   Bridge resin w/noble metal  00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D625300100PPROVISIONAL PONTIC                                                              Provisional pontic          00      9                                          1862a(12)                                                  S                          Y1  9       2003010120030101        N                           
D651900100PINLAY/ONLAY - PORCELAIN/CERAMIC                                                 Inlay/onlay porce/ceramic   00      9                  2136                                                                               M                          Y1  9       200001012003010120021231N                           
D652000100PINLAY-METALLIC-TWO SURFACES                                                     Dental retainer two surfaces00      9                                          1862a(12)                                                  S                          Y1  9       198401012003010120021231N                           
D653000100PINLAY-METALLIC-THREE OR MORE SURFACES                                           Retainer metallic 3+ surface00      9                                          1862a(12)                                                  S                          Y1  9       198401012003010120021231N                           
D654300100PONLAY-METALLIC - THREE SURFACES                                                 Dental retainr onlay 3 surf 00      9                                          1862a(12)                                                  S                          Y1  9       199601012003010120021231N                           
D654400100PONLAY-METALLIC - FOUR OR MORE SURFACES                                          Dental retainr onlay 4/more 00      9                                          1862a(12)                                                  S                          Y1  9       199601012003010120021231N                           
D654500100PRETAINER-CAST METAL FOR RESIN BONDED FIXED PROSTHESIS                           Dental retainr cast metl    00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D654800100PRETAINER - PORCELAIN/CERAMIC FOR RESIN BONDED FIXED PROSTHESIS                  Porcelain/ceramic retainer  00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D660000100PINLAY-PORCELAIN/CERAMIC, TWO SURFACES                                           Porcelain/ceramic inlay 2srf00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D660100100PINLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES                               Porc/ceram inlay >= 3 surfac00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D660200100PINLAY - CAST HIGH NOBLE METAL, TWO SURFACES                                     Cst hgh nble mtl inlay 2 srf00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D660300100PINLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES                           Cst hgh nble mtl inlay >=3sr00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D660400100PINLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES                             Cst bse mtl inlay 2 surfaces00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D660500100PINLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES                   Cst bse mtl inlay >= 3 surfa00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D660600100PINLAY - CAST NOBLE METAL, TWO SURFACES                                          Cast noble metal inlay 2 sur00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D660700100PINLAY - CAST NOBLE METAL, THREE OR MORE SURFACES                                Cst noble mtl inlay >=3 surf00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D660800100PONLAY - PORCELAIN/CERAMIC, TWO SURFACES                                         Onlay porc/crmc 2 surfaces  00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D660900100PONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES                               Onlay porc/crmc >=3 surfaces00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D661000100PONLAY - CAST HIGH NOBLE METAL, TWO SURFACES                                     Onlay cst hgh nbl mtl 2 srfc00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D661100100PONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES                           Onlay cst hgh nbl mtl >=3srf00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D661200100PONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES                             Onlay cst base mtl 2 surface00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D661300100PONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES                   Onlay cst base mtl >=3 surfa00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D661400100PONLAY - CAST NOBLE METAL, TWO SURFACES                                          Onlay cst nbl mtl 2 surfaces00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D661500100PONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES                                Onlay cst nbl mtl >=3 surfac00      9                  2136                                                                               M                          Y1  9       2003010120030101        N                           
D662400100PINLAY - TITANIUM                                                                Inlay titanium              00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D663400100PONLAY - TITANIUM                                                                Onlay titanium              00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D671000100PCROWN - INDIRECT RESIN BASED COMPOSITE                                          Crown-indirect resin based  00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D672000100PCROWN-RESIN WITH HIGH NOBLE METAL                                               Retain crown resin w hi nble00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D672100100PCROWN-RESIN WITH PREDOMINANTLY BASE METAL                                       Crown resin w/base metal    00      9                                          1862a(12)                                                  S                          Y1  9       1986010119960101        N                           
D672200100PCROWN-RESIN WITH NOBLE METAL                                                    Crown resin w/noble metal   00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D674000100PCROWN - PORCELAIN/CERAMIC                                                       Crown porcelain/ceramic     00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D675000100PCROWN-PORCELAIN FUSED TO HIGH NOBLE METAL                                       Crown porcelain high noble  00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D675100100PCROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL                               Crown porcelain base metal  00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D675200100PCROWN-PORCELAIN FUSED TO NOBLE METAL                                            Crown porcelain noble metal 00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D678000100PCROWN-3/4 CAST HIGH NOBLE METAL                                                 Crown 3/4 high noble metal  00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D678100100PCROWN - 3/4 CAST PREDOMINANTLY BASED METAL                                      Crown 3/4 cast based metal  00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D678200100PCROWN - 3/4 CAST NOBLE METAL                                                    Crown 3/4 cast noble metal  00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D678300100PCROWN - 3/4 PORCELAIN/CERAMIC                                                   Crown 3/4 porcelain/ceramic 00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D679000100PCROWN-FULL CAST HIGH NOBLE METAL                                                Crown full high noble metal 00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D679100100PCROWN-FULL CAST PREDOMINANTLY BASE METAL                                        Crown full base metal cast  00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D679200100PCROWN-FULL CAST NOBLE METAL                                                     Crown full noble metal cast 00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D679300100PPROVISIONAL RETAINER CROWN                                                      Provisional retainer crown  00      9                                          1862a(12)                                                  S                          Y1  9       2003010120030101        N                           
D679400100PCROWN - TITANIUM                                                                Crown titanium              00      9                                          1862a(12)                                                  S                          Y1  9       2005010120050101        N                           
D692000100PCONNECTOR BAR                                                                   Dental connector bar        13      A50-26             2336    2136                                                                       D                          Y1  9       1996010119960101        N                           
D693000100PRECEMENT BRIDGE                                                                 Dental recement bridge      00      9                                          1862a(12)                                                  S                          Y1  9       1982010119960101        N                           
D694000100PSTRESS BREAKER                                                                  Stress breaker              00      9                                          1862a(12)                                                  S                          Y1  9       1982010119960101        N                           
D695000100PPRECISION ATTACHMENT                                                            Precision attachment        00      9                                          1862a(12)                                                  S                          Y1  9       1982010119960101        N                           
D697000100PCAST POST AND CORE IN ADDITION TO BRIDGE RETAINER                               Post & core plus retainer   00      9                                          1862a(12)                                                  S                          Y1  9       1986010119960101        N                           
D697100100PCAST POST AS PART OF BRIDGE RETAINER                                            Cast post bridge retainer   00      9                                          1862a(12)                                                  S                          Y1  9       1986010119960101        N                           
D697200100PPREFABRICATED POST AND CORE IN ADDITION TO BRIDGE RETAINER                      Prefab post & core plus reta00      9                                          1862a(12)                                                  S                          Y1  9       1986010119960101        N                           
D697300100PCORE BUILD UP FOR RETAINER, INCLUDING ANY PINS                                  Core build up for retainer  00      9                                          1862a(12)                                                  S                          Y1  9       1992010119960101        N                           
D697500100PCOPING-METAL                                                                    Coping metal                00      9                                          1862a(12)                                                  S                          Y1  9       1992010119960101        N                           
D697600100PEACH ADDITIONAL CAST POST - SAME TOOTH                                          Each addtnl cast post       00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D697700100PEACH ADDITIONAL PREFABRICATED POST - SAME TOOTH                                 Each addtl prefab post      00      9                  2136                                                                               M                          Y1  9       2000010120000101        N                           
D698000100PBRIDGE REPAIR, BY REPORT                                                        Bridge repair               00      9                                          1862a(12)                                                  S                          Y1  9       1986010119960101        N                           
D698500100PPEDIATRIC PARTIAL DENTURE, FIXED                                                Pediatric partial denture fx00      9                                          1862a(12)                                                  S                          Y1  9       2003010120030101        N                           
D699900100PUNSPECIFIED FIXED PROSTHODONTIC PROCEDURE, BY REPORT                            Fixed prosthodontic proc    00      9                                          1862a(12)                                                  S                          Y1  9       1984010119960101        N                           
D711000100PSINGLE TOOTH                                                                    Oral surgery single tooth   13      A                  2136    2336                                                                       D                          Y1  2       198401012003010120021231N                           
D711100100PEXTRACTION, CORONAL REMNANTS - DECIDUOUS TOOTH                                  Extraction coronal remnants 13      A                  2336                                                                               D                          Y1  2       2003010120050101        N                           
D712000100PEACH ADDITIONAL TOOTH                                                           Each add tooth extraction   13      A                  2136    2336                                                                       D                          Y1  2       198401012003010120021231N                           
D713000100PROOT REMOVAL-EXPOSED ROOTS                                                      Tooth root removal          13      A                  2136    2336                                                                       D                          Y1  2       198601012003010120021231N                           
D714000100PEXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)    Extraction erupted tooth/exr13      A                  2336                                                                               D                          Y1  2       2003010120030101        N                           
D721000100PSURGICAL REMOVAL OF ERUPTED TOOTH REQUIRING ELEVATION OF MUCOPERIOSTEAL FLAP    Rem imp tooth w mucoper flp 13      A                  2336    2136                                                                       D                          Y1  2       1984010119930101        N                           
D721000200QAND REMOVAL OF BONE AND/OR SECTION OF TOOTH                                                                                                                                                                                                                                                                          
D722000100PREMOVAL OF IMPACTED TOOTH-SOFT TISSUE                                           Impact tooth remov soft tiss13      A                  2336    2136                                                                       D                          Y1  2       1984010119930101        N                           
D723000100PREMOVAL OF IMPACTED TOOTH-PARTIALLY BONY                                        Impact tooth remov part bony13      A                  2336    2136                                                                       D                          Y1  2       1984010119930101        N                           
D724000100PREMOVAL OF IMPACTED TOOTH-COMPLETELY BONY                                       Impact tooth remov comp bony13      A                  2336    2136                                                                       D                          Y1  2       1984010119930101        N                           
D724100100PREMOVAL OF IMPACTED TOOTH-COMPLETELY BONY, WITH UNUSUAL SURGICAL COMPLICATIONS  Impact tooth rem bony w/comp13      A                  2336    2136                                                                       D                          Y1  2       1984010119930101        N                           
D725000100PSURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)                    Tooth root removal          13      A                  2336    2136                                                                       D                          Y1  2       1984010119930101        N                           
D726000100PORAL ANTRAL FISTULA CLOSURE                                                     Oral antral fistula closure 13      A                  2336    2136                                                                       D                          Y1  2       1984010119930101        N                           
D726100100PPRIMARY CLOSURE OF A SINUS PERFORATION                                          Primary closure sinus perf  13      A                  2336                                                                               D                          Y1  2       2003010120030101        N                           
D727000100PTOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED  Tooth reimplantation        00      9                                          1862a(12)                                                  S                          Y1  2       1984010120030101        N                           
D727000200QTOOTH                                                                                                                                                                                                                                                                                                                
D727200100PTOOTH TRANSPLANTATION (INCLUDES REIMPLANTATION FROM ONE SITE TO ANOTHER AND     Tooth transplantation       00      9                                          1862a(12)                                                  S                          Y1  2       1982010119960101        N                           
D727200200QSPLINTING AND/OR STABILIZATION)                                                                                                                                                                                                                                                                                      
D728000100PSURGICAL ACCESS OF AN UNERUPTED TOOTH                                           Exposure impact tooth orthod00      9                                          1862a(12)                                                  S                          Y1  2       1984010120030101        N                           
D728100100PSURGICAL EXPOSURE OF IMPACTED OR UNERUPTED TOOTH TO AID ERUPTION                Exposure tooth aid eruption 00      9                                          1862a(12)                                                  S                          Y1  2       198401012005010120041231N                           
D728200100PMOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION                  Mobilize erupted/malpos toot00      9                                          1862a(12)                                                  S                          Y1  2       2003010120030101        N                           
D728300100PPLACEMENT OF DEVICE TO FACILITATE ERUPTION OF IMPACTED TOOTH                    Place device impacted tooth 00      9                                                                                                     C                          Y1  9       2005010120050101        N                           
D728500100PBIOPSY OF ORAL TISSUE - HARD (BONE, TOOTH)                                      Biopsy of oral tissue hard  00      9                                                                            20220202252024020245     I                          Y1  2       1984010120000101        N                           
D728600100PBIOPSY OF ORAL TISSUE - SOFT                                                    Biopsy of oral tissue soft  00      9                                                                            40808                    I                          Y1  2       1984010120050101        N                           
D728700100PEXFOLIATIVE CYTOLOGICAL SAMPLE COLLECTION                                       Exfoliative cytolog collect 00      9                                                                                                     I                          Y1  2       2003010120050101        N                           
D728800100PBRUSH BIOPSY - TRANSEPITHELIAL SAMPLE COLLECTION                                Brush biopsy                00      9                                                                                                     C                          Y1  2       2005010120050101        N                           
D729000100PSURGICAL REPOSITIONING OF TEETH                                                 Repositioning of teeth      00      9                                          1862a(12)                                                  S                          Y1  2       1982010119960101        N                           
D729100100PTRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT                      Transseptal fiberotomy      13      A                  2136    2336                                                                       D                          Y1  2       1986010120030101        N                           
D731000100PALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - PER QUADRANT                    Alveoplasty w/ extraction   00      9                                                                            41874                    I                          Y1  2       1984010119960101        N                           
D731100100PALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH     Alveoloplasty w/extract 1-3 00      9                                          1862a(12)                                                  S                          Y1  2       2005010120050101        N                           
D731100200QSPACES, PER QUADRANT                                                                                                                                                                                                                                                                                                 
D732000100PALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - PER QUADRANT                Alveoplasty w/o extraction  00      9                                                                            41870                    I                          Y1  2       1984010119960101        N                           
D732100100PALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH Alveoloplasty not w/extracts00      9                                                                                                     C                          Y1  2       2005010120050101        N                           
D732100200QSPACES, PER QUADRANT                                                                                                                                                                                                                                                                                                 
D734000100PVESTIBULOPLASTY-RIDGE EXTENSION (SECOND EPITHELIALIZATION)                      Vestibuloplasty ridge extens00      9                                                                            40840408424084340844     I                          Y1  2       1984010119960101        N                           
D735000100PVESTIBULOPLASTY-RIDGE EXTENSION (INCLUDING SOFT TISSUE GRAFTS, MUSCLE           Vestibuloplasty exten graft 00      9                                                                            40845                    I                          Y1  2       1984010119960101        N                           
D735000200QRE-ATTACHMENTS, REVISION OF SOFT TISSUE ATTACHMENT, AND MANAGEMENT OF                                                                                                                                                                                                                                                
D735000300QHYPERTROPHIED AND HYPERPLASTIC TISSUE)                                                                                                                                                                                                                                                                               
D741000100PEXCISION OF BENIGN LESION UP TO 1.25 CM                                         Rad exc lesion up to 1.25 cm00      9                                                                            CPT                      I                      0020Y1  2       1982010120030101        N                           
D741100100PEXCISION OF BENIGN LESION GREATER THAN 1.25 CM                                  Excision benign lesion>1.25c00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D741200100PEXCISION OF BENIGN LESION, COMPLICATED                                          Excision benign lesion compl00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D741300100PEXCISION OF MALIGNANT LESION UP TO 1.25 CM                                      Excision malig lesion<=1.25c00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D741400100PEXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM                               Excision malig lesion>1.25cm00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D741500100PEXCISION OF MALIGNANT LESION, COMPLICATED                                       Excision malig les complicat00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D742000100PRADICAL EXCISION-LESION DIAMETER GREATER THAN 1.25 CM                           Lesion > 1.25 cm            00      9                                                                            CPT                      I                      0020Y1  2       198201012003010120021231N                           
D743000100PEXCISION OF BENIGN TUMOR-LESION DIAMETER UP TO 1.25 CM                          Exc benign tumor  to 1.25 cm00      9                                                                            CPT                      I                      0021Y1  2       198401012003010120021231N                           
D743100100PEXCISION OF BENIGN TUMOR-LESION DIAMETER GREATER THAN 1.25 CM                   Benign tumor exc > 1.25 cm  00      9                                                                            CPT                      I                      0021Y1  2       198401012003010120021231N                           
D744000100PEXCISION OF MALIGNANT TUMOR-LESION DIAMETER UP TO 1.25 CM                       Malig tumor exc to 1.25 cm  00      9                                                                            CPT                      I                      0021Y1  2       1984010119960101        N                           
D744100100PEXCISION OF MALIGNANT TUMOR-LESION DIAMETER GREATER THAN 1.25 CM                Malig tumor > 1.25 cm       00      9                                                                            CPT                      I                      0021Y1  2       1984010119960101        N                           
D745000100PREMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP T0 1.25 CM       Rem odontogen cyst to 1.25cm00      9                                                                            CPT                      I                      0021Y1  2       1984010120030101        N                           
D745100100PREMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN 1.25 CMRem odontogen cyst > 1.25 cm00      9                                                                            CPT                      I                      0021Y1  2       1984010120030101        N                           
D746000100PREMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP TO 1.25 CM    Rem nonodonto cyst to 1.25cm00      9                                                                            CPT                      I                      0021Y1  2       1984010120030101        N                           
D746100100PREMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN     Rem nonodonto cyst > 1.25 cm00      9                                                                            CPT                      I                      0021Y1  2       1984010120030101        N                           
D746100200Q1.25 CM                                                                                                                                                                                                                                                                                                              
D746500100PDESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHODS, BY REPORT             Lesion destruction          00      9                                                                            41850                    I                          Y1  2       1984010119960101        N                           
D747100100PREMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)                              Rem exostosis any site      00      9                                                                            2103121032               I                          Y1  2       2000010120030101        N                           
D747200100PREMOVAL OF TORUS PALATINUS                                                      Removal of torus palatinus  00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D747300100PREMOVAL OF TORUS MANDIBULARIS                                                   Remove torus mandibularis   00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D748000100PPARTIAL OSTECTOMY (GUTTERING OR SAUCERIZATION)                                  Partial ostectomy           00      9                                                                            21025                    I                          Y1  2       198201012003010120021231N                           
D748500100PSURGICAL REDUCTION OF OSSEOUS TUBEROSITY                                        Surg reduct osseoustuberosit00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D749000100PRADICAL RESECTION OF MAXILLA OR MANDIBLE                                        Maxilla or mandible resectio00      9                                                                            21095                    I                          Y1  2       1982010120050101        N                           
D751000100PINCISION AND DRAINAGE OF ABSCESS-INTRAORAL SOFT TISSUE                          I&d absc intraoral soft tiss00      9                                                                            41800                    I                          Y1  2       1984010119960101        N                           
D751100100PINCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE - COMPLICATED          Incision/drain abscess intra00      9                                                                                                     C                          Y1  2       2005010120050101        N                           
D751100200Q(INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES)                                                                                                                                                                                                                                                                       
D752000100PINCISION AND DRAINAGE OF ABSCESS-EXTRAORAL SOFT TISSUE                          I&d abscess extraoral       00      9                                                                            40800                    I                          Y1  2       1984010119960101        N                           
D752100100PINCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE - COMPLICATED          Incision/drain abscess extra00      9                                                                                                     C                          Y1  2       2005010120050101        N                           
D752100200Q(INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES)                                                                                                                                                                                                                                                                       
D753000100PREMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE      Removal fb skin/areolar tiss00      9                                                                            4180541828               I                          Y1  2       1984010120030101        N                           
D754000100PREMOVAL OF REACTION-PRODUCING FOREIGN BODIES-MUSCULOSKELETAL SYSTEM             Removal of fb reaction      00      9                                                                            205204180041806          I                          Y1  2       1984010119960101        N                           
D755000100PPARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE                  Removal of sloughed off bone00      9                                                                            20999                    I                          Y1  2       1982010120030101        N                           
D756000100PMAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY              Maxillary sinusotomy        00      9                                                                            31020                    I                          Y1  2       1982010119960101        N                           
D761000100PMAXILLA-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT)                           Maxilla open reduct simple  00      9                                                                            CPT                      I                      0022Y1  2       1984010119960101        N                           
D762000100PMAXILLA-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT)                         Clsd reduct simpl maxilla fx00      9                                                                            CPT                      I                      0023Y1  2       1984010119960101        N                           
D763000100PMANDIBLE-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT)                          Open red simpl mandible fx  00      9                                                                            CPT                      I                      0024Y1  2       1984010119960101        N                           
D764000100PMANDIBLE-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT)                        Clsd red simpl mandible fx  00      9                                                                            CPT                      I                      0025Y1  2       1984010119960101        N                           
D765000100PMALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION                                      Open red simp malar/zygom fx00      9                                                                            CPT                      I                      0026Y1  2       1984010119960101        N                           
D766000100PMALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION                                    Clsd red simp malar/zygom fx00      9                                                                            CPT                      I                      0027Y1  2       1984010119960101        N                           
D767000100PALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH                 Closd rductn splint alveolus00      9                                                                            CPT                      I                      0028Y1  2       1984010120030101        N                           
D767100100PALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH                   Alveolus open reduction     00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D768000100PFACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL          Reduct simple facial bone fx00      9                                                                            CPT                      I                      0029Y1  2       1982010119960101        N                           
D768000200QAPPROACHES                                                                                                                                                                                                                                                                                                           
D771000100PMAXILLA-OPEN REDUCTION                                                          Maxilla open reduct compound00      9                                                                            21346                    I                          Y1  2       1984010119960101        N                           
D772000100PMAXILLA-CLOSED REDUCTION                                                        Clsd reduct compd maxilla fx00      9                                                                            21345                    I                          Y1  2       1984010119960101        N                           
D773000100PMANDIBLE-OPEN REDUCTION                                                         Open reduct compd mandble fx00      9                                                                            2146121462               I                          Y1  2       1984010119960101        N                           
D774000100PMANDIBLE-CLOSED REDUCTION                                                       Clsd reduct compd mandble fx00      9                                                                            21455                    I                          Y1  2       1984010119960101        N                           
D775000100PMALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION                                      Open red comp malar/zygma fx00      9                                                                            2136021365               I                          Y1  2       1984010119960101        N                           
D776000100PMALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION                                    Clsd red comp malar/zygma fx00      9                                                                            21355                    I                          Y1  2       1984010119960101        N                           
D777000100PALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH                                Open reduc compd alveolus fx00      9                                                                            21422                    I                          Y1  2       1984010120030101        N                           
D777100100PALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH                               Alveolus clsd reduc stblz te00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D778000100PFACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL          Reduct compnd facial bone fx00      9                                                                            2143321435               I                          Y1  2       1982010119960101        N                           
D778000200QAPPROACHES                                                                                                                                                                                                                                                                                                           
D781000100POPEN REDUCTION OF DISLOCATION                                                   Tmj open reduct-dislocation 00      9                                                                            21490                    I                          Y1  2       1982010119960101        N                           
D782000100PCLOSED REDUCTION OF DISLOCATION                                                 Closed tmp manipulation     00      9                                                                            21480                    I                          Y1  2       1982010119960101        N                           
D783000100PMANIPULATION UNDER ANESTHESIA                                                   Tmj manipulation under anest00      9                                                                            00190                    I                          Y1  2       1982010119960101        N                           
D784000100PCONDYLECTOMY                                                                    Removal of tmj condyle      00      9                                                                            21050                    I                          Y1  2       1982010119960101        N                           
D785000100PSURGICAL DISCECTOMY; WITH/WITHOUT IMPLANT                                       Tmj meniscectomy            00      9                                                                            21060                    I                          Y1  2       1984010119960101        N                           
D785200100PDISC REPAIR                                                                     Tmj repair of joint disc    00      9                                                                            21299                    I                          Y1  2       1992010119960101        N                           
D785400100PSYNOVECTOMY                                                                     Tmj excisn of joint membrane00      9                                                                            21299                    I                          Y1  2       1992010119960101        N                           
D785600100PMYOTOMY                                                                         Tmj cutting of a muscle     00      9                                                                            21299                    I                          Y1  2       1992010119960101        N                           
D785800100PJOINT RECONSTRUCTION                                                            Tmj reconstruction          00      9                                                                            2124221243               I                          Y1  2       1992010119960101        N                           
D786000100PARTHROTOMY                                                                      Tmj cutting into joint      00      9                  2336    2136                                                                       I                          Y1  2       1982010119960101        N                           
D786500100PARTHROPLASTY                                                                    Tmj reshaping components    00      9                                                                            21240                    I                          Y1  2       1992010119960101        N                           
D787000100PARTHROCENTESIS                                                                  Tmj aspiration joint fluid  00      9                                                                            21060                    I                          Y1  2       1982010119960101        N                           
D787100100PNON-ARTHROSCOPIC LYSIS AND LAVAGE                                               Lysis + lavage w catheters  00      9                                          1862a(12)                                                  S                          Y1  2       2000010120000101        N                           
D787200100PARTHROSCOPY-DIAGNOSIS, WITH OR WITHOUT BIOPSY                                   Tmj diagnostic arthroscopy  00      9                                                                            29800                    I                          Y1  2       1992010119960101        N                           
D787300100PARTHROSCOPY-SURGICAL: LAVAGE AND LYSIS OF ADHESIONS                             Tmj arthroscopy lysis adhesn00      9                                                                            29804                    I                          Y1  2       1992010119960101        N                           
D787400100PARTHROSCOPY-SURGICAL: DISC REPOSITIONING AND STABILIZATION                      Tmj arthroscopy disc reposit00      9                                                                            29804                    I                          Y1  2       1992010119960101        N                           
D787500100PARTHROSCOPY-SURGICAL: SYNOVECTOMY                                               Tmj arthroscopy synovectomy 00      9                                                                            29804                    I                          Y1  2       1992010119960101        N                           
D787600100PARTHROSCOPY-SURGICAL: DISCECTOMY                                                Tmj arthroscopy discectomy  00      9                                                                            29804                    I                          Y1  2       1992010119960101        N                           
D787700100PARTHROSCOPY-SURGICAL: DEBRIDEMENT                                               Tmj arthroscopy debridement 00      9                                                                            29804                    I                          Y1  2       1992010119960101        N                           
D788000100POCCLUSAL ORTHOTIC APPLIANCE                                                     Occlusal orthotic appliance 00      9                                                                            21499                    I                          Y1  2       1986010119960101        N                           
D789900100PUNSPECIFIED TMD THERAPY, BY REPORT                                              Tmj unspecified therapy     00      9                                                                            21499                    I                          Y1  2       1992010119960101        N                           
D791000100PSUTURE OF RECENT SMALL WOUNDS UP TO 5 CM                                        Dent sutur recent wnd to 5cm00      9                                                                            1201112013               I                          Y1  2       1984010119960101        N                           
D791100100PCOMPLICATED SUTURE-UP TO 5 CM                                                   Dental suture wound to 5 cm 00      9                                                                            1205112052               I                          Y1  2       1984010119960101        N                           
D791200100PCOMPLICATED SUTURE-GREATER THAN 5 CM                                            Suture complicate wnd > 5 cm00      9                                                                            13132                    I                          Y1  2       1984010119960101        N                           
D792000100PSKIN GRAFT (IDENTIFY DEFECT COVERED, LOCATION, AND TYPE OF GRAFT)               Dental skin graft           00      9                                                                            CPT                      I                      0030Y1  2       1984010119960101        N                           
D794000100POSTEOPLASTY-FOR ORTHOGNATHIC DEFORMITIES                                        Reshaping bone orthognathic 13      A                  2336    2136                                                                       D                          Y1  2       1982010119930101        N                           
D794100100POSTEOTOMY - MANDIBULAR RAMI                                                     Bone cutting ramus closed   00      9                                                                            211932119521196          I                          Y1  2       1984010120000101        N                           
D794300100POSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLUDES OBTAINING THE GRAFT       Cutting ramus open w/graft  00      9                                                                            21194                    I                          Y1  2       1984010120000101        N                           
D794400100POSTEOTOMY-SEGMENTED OR SUBAPICAL-PER SEXTANT OR QUADRANT                        Bone cutting segmented      00      9                                                                            2119821206               I                          Y1  2       1984010119960101        N                           
D794500100POSTEOTOMY-BODY OF MANDIBLE                                                      Bone cutting body mandible  00      9                                                                            21193211942119521196     I                          Y1  2       1984010119960101        N                           
D794600100PLEFORT I (MAXILLA-TOTAL)                                                        Reconstruction maxilla total00      9                                                                            21147                    I                          Y1  2       1984010119960101        N                           
D794700100PLEFORT I (MAXILLA-SEGMENTED)                                                    Reconstruct maxilla segment 00      9                                                                            2114521146               I                          Y1  2       1984010119960101        N                           
D794800100PLEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL BONES FOR MIDFACE HYPOPLASIA OR  Reconstruct midface no graft00      9                                                                            21150                    I                          Y1  2       1984010119960101        N                           
D794800200QRETRUSION)-WITHOUT BONE GRAFT                                                                                                                                                                                                                                                                                        
D794900100PLEFORT II OR LEFORT III-WITH BONE GRAFT                                         Reconstruct midface w/graft 00      9                                                                            CPT                      I                      0031Y1  2       1984010119960101        N                           
D795000100POSSEOUS, OSTEOPERIOSTEAL, OR CARTILAGE GRAFT OF THE MANDIBLE OR FACIAL          Mandible graft              00      9                                                                            21247                    I                          Y1  2       1984010119960101        N                           
D795000200QBONES-AUTOGENOUS OR NONAUTOGENOUS, BY REPORT                                                                                                                                                                                                                                                                         
D795300100PBONE REPLACEMENT GRAFT FOR RIDGE PRESERVATION - PER SITE                        Bone replacement graft      00      9                                          1862a(12)                                                  S                          Y1  2       2005010120050101        N                           
D795500100PREPAIR OF MAXILLOFACIAL SOFT AND/OR HARD TISSUE DEFECT                          Repair maxillofacial defects00      9                                                                            21299                    I                          Y1  2       1982010120050101        N                           
D796000100PFRENULECTOMY (FRENECTOMY OR FRENOTOMY)-SEPARATE PROCEDURE                       Frenulectomy/frenulotomy    00      9                                                                            408194101041115          I                          Y1  2       1984010119960101        N                           
D796300100PFRENULOPLASTY                                                                   Frenuloplasty               00      9                                          1862a(12)                                                  S                          Y1  2       2005010120050101        N                           
D797000100PEXCISION OF HYPERPLASTIC TISSUE-PER ARCH                                        Excision hyperplastic tissue00      9                                                                            CPT                      I                      0032Y1  2       1984010119960101        N                           
D797100100PEXCISION OF PERICORONAL GINGIVA                                                 Excision pericoronal gingiva00      9                                                                            41821                    I                          Y1  2       1986010119960101        N                           
D797200100PSURGICAL REDUCTION OF FIBROUS TUBEROSITY                                        Surg redct fibrous tuberosit00      9                                                                                                     I                          Y1  2       2003010120030101        N                           
D798000100PSIALOLITHOTOMY                                                                  Sialolithotomy              00      9                                                                            423304233542340          I                          Y1  2       1982010119960101        N                           
D798100100PEXCISION OF SALIVARY GLAND, BY REPORT                                           Excision of salivary gland  00      9                                                                            42408                    I                          Y1  2       1982010119960101        N                           
D798200100PSIALODOCHOPLASTY                                                                Sialodochoplasty            00      9                                                                            42500                    I                          Y1  2       1984010119960101        N                           
D798300100PCLOSURE OF SALIVARY FISTULA                                                     Closure of salivary fistula 00      9                                                                            42600                    I                          Y1  2       1982010119960101        N                           
D799000100PEMERGENCY TRACHEOTOMY                                                           Emergency tracheotomy       00      9                                                                            31605                    I                          Y1  2       1982010119960101        N                           
D799100100PCORONOIDECTOMY                                                                  Dental coronoidectomy       00      9                                                                            21070                    I                          Y1  2       1985010119960101        N                           
D799500100PSYNTHETIC GRAFT-MANDIBLE OR FACIAL BONES, BY REPORT                             Synthetic graft facial bones00      9                                                                            21299                    I                          Y1  2       1996010119960101        N                           
D799600100PIMPLANT-MANDIBLE FOR AUGMENTATION PURPOSES (EXCLUDING ALVEOLAR RIDGE), BY REPORTImplant mandible for augment00      9                                                                            21299                    I                          Y1  2       1996010119960101        N                           
D799700100PAPPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED APPLIANCE), INCLUDES REMOVAL OF    Appliance removal           00      9                                          1862a(12)                                                  S                          Y1  2       2000010120000101        N                           
D799700200QARCHBAR                                                                                                                                                                                                                                                                                                              
D799900100PUNSPECIFIED ORAL SURGERY PROCEDURE, BY REPORT                                   Oral surgery procedure      00      9                                                                            21299                    I                          Y1  2       1984010119960101        N                           
D801000100PLIMITED ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION                          Limited dental tx primary   00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D802000100PLIMITED ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION                     Limited dental tx transition00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D803000100PLIMITED ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION                       Limited dental tx adolescent00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D804000100PLIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION                            Limited dental tx adult     00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D805000100PINTERCEPTIVE ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION                     Intercep dental tx primary  00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D806000100PINTERCEPTIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION                Intercep dental tx transitn 00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D807000100PCOMPREHENSIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION               Compre dental tx transition 00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D808000100PCOMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION                 Compre dental tx adolescent 00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D809000100PCOMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION                      Compre dental tx adult      00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D821000100PREMOVABLE APPLIANCE THERAPY                                                     Orthodontic rem appliance tx00      9                                          1862a(12)                                                  S                          Y1  1       1982010119960101        N                           
D822000100PFIXED APPLIANCE THERAPY                                                         Fixed appliance therapy habt00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D866000100PPRE-ORTHODONTIC VISIT                                                           Preorthodontic tx visit     00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D867000100PPERIODIC ORTHODONTIC TREATMENT VISIT (AS PART OF CONTRACT)                      Periodic orthodontc tx visit00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D868000100PORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONSTRUCTION AND PLACEMENT OF     Orthodontic retention       00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D868000200QRETAINER(S))                                                                                                                                                                                                                                                                                                         
D869000100PORTHODONTIC TREATMENT (ALTERNATIVE BILLING TO A CONTRACT FEE)                   Orthodontic treatment       00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D869100100PREPAIR OF ORTHODONTIC APPLIANCE                                                 Repair ortho appliance      00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D869200100PREPLACEMENT OF LOST OR BROKEN RETAINER                                          Replacement retainer        00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D899900100PUNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT                                    Orthodontic procedure       00      9                                          1862a(12)                                                  S                          Y1  1       1984010119960101        N                           
D911000100PPALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN-MINOR PROCEDURES                Tx dental pain minor proc   13      A                  2336    2136                                                                       D                          Y1  1       1984010119960101        N                           
D921000100PLOCAL ANESTHESIA  N0T IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES      Dent anesthesia w/o surgery 00      9                                                                            90784                    I                          Y1  7       1984010119960101        N                           
D921100100PREGIONAL BLOCK ANESTHESIA                                                       Regional block anesthesia   00      9                                                                            01995                    I                          Y1  7       1982010119960101        N                           
D921200100PTRIGEMINAL DIVISION BLOCK ANESTHESIA                                            Trigeminal block anesthesia 00      9                                                                            64400                    I                          Y1  7       1985010119960101        N                           
D921500100PLOCAL ANESTHESIA                                                                Local anesthesia            00      9                                                                            90784                    I                          Y1  7       1985010119960101        N                           
D922000100PDEEP SEDATION/GENERAL ANESTHESIA-FIRST 30 MINUTES                               General anesthesia          00      9                                                                            CPT                      I                      0034Y1  7       1982010120030101        N                           
D922100100PDEEP SEDATION/GENERAL ANESTHESIA-EACH ADDITIONAL 15 MINUTES                     General anesthesia ea ad 15m00      9                  2136    2336                                                                       I                          Y1  7       1992010120030101        N                           
D923000100PANALGESIA, ANXIOLYSIS, INHALATION OF NITROUS OXIDE                              Analgesia                   13      A                  2136    2336                                                                       D                          Y1  7       1982010120000101        N                           
D924100100PINTRAVENOUS CONSCIOUS SEDATION/ANALGESIA - FIRST 30 MINUTES                     Intravenous sedation        00      9                                                                            90784                    I                          Y1  7       2000010120030101        N                           
D924200100PINTRAVENOUS CONSCIOUS SEDATION/ANALGESIA - EACH ADDITIONAL 15 MINUTES           IV sedation ea ad 30 m      00      9                                                                            90784                    I                          Y1  7       2000010120030101        N                           
D924800100PNON-INTRAVENOUS CONSCIOUS SEDATION                                              Sedation (non-iv)           00      9                                                                                                     D                      0052Y1  7       2000010120000101        N                           
D931000100PCONSULTATION (DIAGNOSTIC SERVICE PROVIDED BY DENTIST OR PHYSICIAN OTHER THAN    Dental consultation         00      9                                                                            CPT                      I                      0035Y1  3       1982010119960101        N                           
D931000200QPRACTITIONER PROVIDING TREATMENT)                                                                                                                                                                                                                                                                                    
D941000100PHOUSE/EXTENDED CARE FACILITY CALL                                               Dental house call           00      9                                                                            CPT                      I                      0036Y1  1       1984010120000101        N                           
D942000100PHOSPITAL CALL                                                                   Hospital call               00      9                                                                            CPT                      I                      0037Y1  1       1984010119960101        N                           
D943000100POFFICE VISIT FOR OBSERVATION (DURING REGULARLY SCHEDULED HOURS) NO OTHER        Office visit during hours   00      9                                                                            CPT                      I                      0038Y1  1       1984010119960101        N                           
D943000200QSERVICES PERFORMED                                                                                                                                                                                                                                                                                                   
D944000100POFFICE VISIT-AFTER REGULARLY SCHEDULED HOURS                                    Office visit after hours    00      9                                                                            99050                    I                          Y1  1       1984010119960101        N                           
D945000100PCASE PRESENTATION, DETAILED AND EXTENSIVE TREATMENT PLANNING                    Case presentation tx plan   00      9                                                                                                     I                          Y1  1       2003010120030101        N                           
D961000100PTHERAPEUTIC DRUG INJECTION, BY REPORT                                           Dent therapeutic drug inject00      9                                                                            9078890784               I                          Y1  9       1984010119960101        N                           
D963000100POTHER DRUGS AND/OR MEDICAMENTS, BY REPORT                                       Other drugs/medicaments     13      A                  2336    2136                                                                       D                          Y1  9       1984010119930101        N                           
D991000100PAPPLICATION OF DESENSITIZING MEDICAMENT                                         Dent appl desensitizing med 00      9                                          1862a(12)                                                  S                          Y1  1       1985010119960101        N                           
D991100100PAPPLICATION OF DESENSITIZING RESIN FOR CERVICAL AND/OR ROOT SURFACE, PER TOOTH  Appl desensitizing resin    00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D992000100PBEHAVIOR MANAGEMENT, BY REPORT                                                  Behavior management         00      9                                          1862a(12)                                                  S                          Y1  1       1986010119960101        N                           
D993000100PTREATMENT OF COMPLICATIONS (POSTSURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT    Treatment of complications  13      A                  2336    2136                                                                       D                          Y1  1       1984010119930101        N                           
D994000100POCCLUSAL GUARDS, BY REPORT                                                      Dental occlusal guard       13      A                  2336    2136                                                                       D                          Y1  1       1986010119960101        N                           
D994100100PFABRICATION OF ATHLETIC MOUTHGUARD                                              Fabrication athletic guard  00      9                                          1862a(12)                         21089                    S                          Y1  1       1986010119960101        N                           
D994200100PREPAIR AND/OR RELINE OF OCCLUSAL GUARD                                          Repair/reline occlusal guard00      9                                          1862a(12)                                                  S                          Y1  1       2005010120050101        N                           
D995000100POCCLUSION ANALYSIS-MOUNTED CASE                                                 Occlusion analysis          13      A                  2336    2136                                                                       D                          Y1  1       1984010119930101        N                           
D995100100POCCLUSAL ADJUSTMENT-LIMITED                                                     Limited occlusal adjustment 13      A                  2336    2136                                                                       D                          Y1  1       1986010119930101        N                           
D995200100POCCLUSAL ADJUSTMENT-COMPLETE                                                    Complete occlusal adjustment13      A                  2336    2136                                                                       D                          Y1  1       1986010119930101        N                           
D997000100PENAMEL MICROABRASION                                                            Enamel microabrasion        00      9                                          1862a(12)                                                  S                          Y1  1       1996010119960101        N                           
D997100100PODONTOPLASTY 1 - 2 TEETH; INCLUDES REMOVAL OF ENAMEL PROJECTIONS                Odontoplasty 1-2 teeth      00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D997200100PEXTERNAL BLEACHING  - PER ARCH                                                  Extrnl bleaching per arch   00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D997300100PEXTERNAL BLEACHING - PER TOOTH                                                  Extrnl bleaching per tooth  00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D997400100PINTERNAL BLEACHING - PER TOOTH                                                  Intrnl bleaching per tooth  00      9                                          1862a(12)                                                  S                          Y1  1       2000010120000101        N                           
D999900100PUNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT                                     Adjunctive procedure        00      9                                                                            21499                    I                          Y1  1       1984010119960101        N                           
E010000100PCANE, 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     1986010119960101        N                           
E010500100PCANE, 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     1986010119960101        N                           
E010500200QFIXED, WITH TIPS                                                                                                                                                                                                                                                                                                     
E011000100PCRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, Crutch forearm pair         32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E011000200QPAIR, COMPLETE WITH TIPS AND HANDGRIPS                                                                                                                                                                                                                                                                               
E011100100PCRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED,    Crutch forearm each         32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E011100200QEACH, WITH TIP AND HANDGRIPS                                                                                                                                                                                                                                                                                         
E011200100PCRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS AND         Crutch underarm pair wood   32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E011200200QHANDGRIPS                                                                                                                                                                                                                                                                                                            
E011300100PCRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH, WITH PAD, TIP AND HANDGRIP    Crutch underarm each wood   32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E011400100PCRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS  Crutch underarm pair no wood32      A60-9              2100.1                                                                             D                          D1E APR     1986010119970101        N                           
E011400200QAND HANDGRIPS                                                                                                                                                                                                                                                                                                        
E011600100PCRUTCH, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, WITH PAD, TIP,          Crutch underarm each no wood32      A60-9              2100.1                                                                             D                          D1E APR     1986010120060101        C                           
E011600200QHANDGRIP, WITH OR WITHOUT SHOCK ABSORBER, EACH                                                                                                                                                                                                                                                                       
E011700100PCRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH                           Underarm springassist crutch32      A                  2100.1                                                                             D                          D1E APR     2003010120030101        N                           
E011800100PCRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WITHOUT WHEELS, EACH             Crutch substitute           32      A                                                                                                     C                          D1E APR     2004010120040401        N                           
E013000100PWALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT                              Walker rigid adjust/fixed ht32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E013500100PWALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT                            Walker folding adjust/fixed 32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E014000100PWALKER, WITH TRUNK SUPPORT, ADJUSTABLE OR FIXED HEIGHT, ANY TYPE                Walker w trunk support      32      A60-9              2100.1                                                                             D                          D1E APR     2004010120040101        N                           
E014100100PWALKER, RIGID, WHEELED, ADJUSTABLE OR FIXED HEIGHT                              Rigid wheeled walker adj/fix32      A60-9              2100.1                                                                             D                          D1E APR     1986010120040101        N                           
E014200100PRIGID WALKER, WHEELED, WITH SEAT                                                Walker rigid wheeled with se32      A60-9              2100.1                                                                             D                          D1E APR     198601012004010120031231N                           
E014300100PWALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT                            Walker folding wheeled w/o s32      A60-9              2100.1                                                                             D                          D1E APR     1986010120040101        N                           
E014400100PWALKER, ENCLOSED, FOUR SIDED FRAMED, RIGID OR FOLDING, WHEELED WITH POSTERIOR   Enclosed walker w rear seat 36      A60-9              2100.1                                                                             D                          D1E APR     2000010120040101        N                           
E014400200QSEAT                                                                                                                                                                                                                                                                                                                 
E014500100PWALKER, WHEELED, WITH SEAT AND CRUTCH ATTACHMENTS                               Walker whled seat/crutch att36      A60-9              2100.1                                                                             D                          D1E R       198601012004010120031231N                           
E014600100PFOLDING WALKER, WHEELED, WITH SEAT                                              Folding walker wheels w seat36      A60-9              2100.1                                                                             D                          D1E R       198601012004010120031231N                           
E014700100PWALKER, HEAVY DUTY, MULTIPLE BRAKING SYSTEM, VARIABLE WHEEL RESISTANCE          Walker variable wheel resist32      A60-15             2100.1                                                                             D                          D1E APR     1986010120040101        N                           
E014800100PWALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDING, ANY TYPE, EACH            Heavyduty walker no wheels  32      A                                                                                                     C                          D1E APR     2001010120010101        N                           
E014900100PWALKER, HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY TYPE                         Heavy duty wheeled walker   32      A                                                                                                     C                          D1E APR     2001010120040101        N                           
E015300100PPLATFORM ATTACHMENT, FOREARM CRUTCH, EACH                                       Forearm crutch platform atta32      A                                                                                                     C                          D1E APR     1986010119960101        N                           
E015400100PPLATFORM ATTACHMENT, WALKER, EACH                                               Walker platform attachment  32      A                                                                                                     C                          D1E APR     1986010119960101        N                           
E015500100PWHEEL ATTACHMENT, RIGID PICK-UP WALKER, PER PAIR                                Walker wheel attachment,pair32      A                                                                                                     C                          D1E APR     1986010120000101        N                           
E015600100PSEAT ATTACHMENT, WALKER                                                         Walker seat attachment      32      A                                                                                                     C                          D1E APR     1986010119960101        N                           
E015700100PCRUTCH ATTACHMENT, WALKER, EACH                                                 Walker crutch attachment    32      A                                                                                                     C                          D1E APR     1986010119960101        N                           
E015800100PLEG EXTENSIONS FOR WALKER, PER SET OF FOUR (4)                                  Walker leg extenders set of432      A                                                                                                     C                          D1E APR     1986010120000101        N                           
E015900100PBRAKE ATTACHMENT FOR WHEELED WALKER, REPLACEMENT, EACH                          Brake for wheeled walker    32      A                                                                                                     C                          D1E APR     1997010119980101        N                           
E016000100PSITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE             Sitz type bath or equipment 32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E016100100PSITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE, WITH       Sitz bath/equipment w/faucet32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E016100200QFAUCET ATTACHMENT/S                                                                                                                                                                                                                                                                                                  
E016200100PSITZ BATH CHAIR                                                                 Sitz bath chair             32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E016300100PCOMMODE CHAIR, STATIONARY, WITH FIXED ARMS                                      Commode chair stationry fxd 32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E016400100PCOMMODE CHAIR, MOBILE, WITH FIXED ARMS                                          Commode chair mobile fixed a32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E016500100PCOMMODE CHAIR, STATIONARY, WITH DETACHABLE ARMS                                 Commode chair stationry det 36      A60-9              2100.1                                                                             D                          D1E R       1986010119960101        N                           
E016600100PCOMMODE CHAIR, MOBILE, WITH DETACHABLE ARMS                                     Commode chair mobile detach 36      A60-9              2100.1                                                                             D                          D1E R       1986010119960101        N                           
E016700100PPAIL OR PAN FOR USE WITH COMMODE CHAIR                                          Commode chair pail or pan   32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E016800100PCOMMODE CHAIR, EXTRA WIDE AND/OR HEAVY DUTY, STATIONARY OR MOBILE, WITH OR      Heavyduty/wide commode chair32      A                                                                                                     C                          D1E APR     2001010120010101        N                           
E016800200QWITHOUT ARMS, ANY TYPE, EACH                                                                                                                                                                                                                                                                                         
E016900100PCOMMODE CHAIR WITH SEAT LIFT MECHANISM                                          Seatlift incorp commodechair36      A                                                                                                     C                          D1E R       200201012006010120051231D                           
E017000100PCOMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, ELECTRIC, ANY TYPE           Commode chair electric      36      A                                                                                                     C                          D1E APR     2006010120060101        A                           
E017100100PCOMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, NON-ELECTRIC, ANY TYPE       Commode chair non-electric  36      A                                                                                                     C                          D1E APR     2006010120060101        A                           
E017200100PSEAT LIFT MECHANISM PLACED OVER OR ON TOP OF TOILET, ANY TYPE                   Seat lift mechanism toilet  00      9                                          1861SSA                                                    S                          D1E APR     2006010120060101        A                           
E017500100PFOOT REST, FOR USE WITH COMMODE CHAIR, EACH                                     Commode chair foot rest     32      A                                                                                                     C                          D1E APR     1986010119960101        N                           
E017600100PAIR PRESSURE PAD OR CUSHION, NONPOSITIONING                                     Air pressre pad/cushion nonp32      A60-9                                                                                                 D                          D1E APR     199101012005010120041231N                           
E017700100PWATER PRESSURE PAD OR CUSHION, NONPOSITIONING                                   Water press pad/cushion nonp32      A60-9                                                                                                 D                          D1E APR     199101012005010120041231N                           
E017800100PGEL OR GEL-LIKE PRESSURE PAD OR CUSHION, NONPOSITIONING                         Gel pressre pad/cushion nonp32      A60-9                                                                                                 D                          D1E APR     199101012005010120041231N                           
E017900100PDRY PRESSURE PAD OR CUSHION, NONPOSITIONING                                     Dry pressre pad/cushion nonp32      A60-9                                                                                                 D                          D1E APR     199101012005010120041231N                           
E018000100PPRESSURE PAD, ALTERNATING WITH PUMP                                             Press pad alternating w pump36      A60-9              4107.6                                                                             D                          D1E R       1986010119960101        N                           
E018100100PPRESSURE PAD, ALTERNATING WITH PUMP, HEAVY DUTY                                 Press pad alternating w/ pum36      A60-9              4107.6                                                                             D                          D1E R       1986010119960101        N                           
E018200100PPUMP FOR ALTERNATING PRESSURE PAD                                               Pressure pad alternating pum36      A60-9              4107.6                                                                             D                          D1E R       1986010119960101        N                           
E018400100PDRY PRESSURE MATTRESS                                                           Dry pressure mattress       32      A60-9              4107.6                                                                             D                          D1E APR     1986010119960101        N                           
E018500100PGEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH   Gel pressure mattress pad   32      A60-9              4107.6                                                                             D                          D1E APR     1986010119980101        N                           
E018600100PAIR PRESSURE MATTRESS                                                           Air pressure mattress       36      A60-9                                                                                                 D                          D1E R       1986010119960101        N                           
E018700100PWATER PRESSURE MATTRESS                                                         Water pressure mattress     36      A60-9                                                                                                 D                          D1E R       1986010119960101        N                           
E018800100PSYNTHETIC SHEEPSKIN PAD                                                         Synthetic sheepskin pad     32      A60-9              4107.6                                                                             D                          D1E APR     1986010120010101        N                           
E018900100PLAMBSWOOL SHEEPSKIN PAD, ANY SIZE                                               Lambswool sheepskin pad     32      A60-9              4107.6                                                                             D                          D1E APR     1986010120010101        N                           
E019000100PPOSITIONING CUSHION/PILLOW/WEDGE, ANY SHAPE OR SIZE                             Positioning cushion         00      9                  2100.1                                                                             D                          D1E 9       2004010120040101        N                           
E019100100PHEEL OR ELBOW PROTECTOR, EACH                                                   Protector heel or elbow     32      A                                                                                                     C                          D1E APR     1986010119960101        N                           
E019200100PLOW PRESSURE AND POSITIONING EQUALIZATION PAD, FOR WHEELCHAIR                   Pad wheelchr low press/posit00      9                                                                                                     I                          D1D APR     198701012005010120041231N                           
E019300100PPOWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY)                                Powered air flotation bed   36      A                                                                                                     C                          D1E R       1990010119930101        N                           
E019400100PAIR FLUIDIZED BED                                                               Air fluidized bed           36      A60-19                                                                                                D                      0013D1E R       1991010119910101        N                           
E019600100PGEL PRESSURE MATTRESS                                                           Gel pressure mattress       36      A60-9                                                                                                 D                          D1E R       1991010119910101        N                           
E019700100PAIR PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH               Air pressure pad for mattres32      A60-9                                                                                                 D                          D1E APR     1991010119980101        N                           
E019800100PWATER PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH             Water pressure pad for mattr32      A60-9                                                                                                 D                          D1E APR     1991010119980101        N                           
E019900100PDRY PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH               Dry pressure pad for mattres32      A60-9                                                                                                 D                          D1E APR     1991010119980101        N                           
E020000100PHEAT LAMP, WITHOUT STAND (TABLE MODEL), INCLUDES BULB, OR INFRARED ELEMENT      Heat lamp without stand     32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E020200100PPHOTOTHERAPY (BILIRUBIN) LIGHT WITH PHOTOMETER                                  Phototherapy light w/ photom36      A                                                                                                     C                          D1E R       1985010119960101        N                           
E020300100PTHERAPEUTIC LIGHTBOX, MINIMUM 10,000 LUX, TABLE TOP MODEL                       Therapeutic lightbox tabletp00      960-9                                                                                                 M                          D1E 9       2003010120050101        F                           
E020500100PHEAT LAMP, WITH STAND, INCLUDES BULB, OR INFRARED ELEMENT                       Heat lamp with stand        32      A60-9              2100.1                                                                             D                          D1E APR     1986010119960101        N                           
E021000100PELECTRIC HEAT PAD, STANDARD                                                     Electric heat pad standard  32      A60-9                                                                                                 D                          D1E ALPR    1986010120030101        N                           
E021500100PELECTRIC HEAT PAD, MOIST                                                        Electric heat pad moist     32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E021700100PWATER CIRCULATING HEAT PAD WITH PUMP                                            Water circ heat pad w pump  32      A60-9                                                                                                 D                          D1E APR     1997010119970101        N                           
E021800100PWATER CIRCULATING COLD PAD WITH PUMP                                            Water circ cold pad w pump  36      A60-9                                                                                                 D                          D1E APR     1997010119970101        N                           
E022000100PHOT WATER BOTTLE                                                                Hot water bottle            32      A                                                                                                     C                          D1E APR     1986010119960101        N                           
E022100100PINFRARED HEATING PAD SYSTEM                                                     Infrared heating pad system 00      960-25                                                                                                M                          D1E APR     2002010120050101        N                           
E022500100PHYDROCOLLATOR UNIT, INCLUDES PADS                                               Hydrocollator unit          32      A60-9              2210.3                                                                             D                          D1E APR     1986010119960101        N                           
E023000100PICE CAP OR COLLAR                                                               Ice cap or collar           32      A                                                                                                     C                          D1E APR     1986010119960101        N                           
E023100100PNON-CONTACT WOUND WARMING DEVICE (TEMPERATURE CONTROL UNIT, AC ADAPTER AND      Wound warming device        00      9                  2303                                                                               M                          D1E R       2002010120020701        N                           
E023100200QPOWER CORD) FOR USE WITH WARMING CARD AND WOUND COVER                                                                                                                                                                                                                                                                
E023200100PWARMING CARD FOR USE WITH THE NON CONTACT WOUND WARMING DEVICE AND NON CONTACT  Warming card for NWT        00      9                  2303                                                                               M                          D1E P       2002010120020701        N                           
E023200200QWOUND WARMING WOUND COVER                                                                                                                                                                                                                                                                                            
E023500100PPARAFFIN BATH UNIT, PORTABLE (SEE MEDICAL SUPPLY CODE A4265 FOR PARAFFIN)       Paraffin bath unit portable 36      A60-9              2210.3                                                                             D                          D1E R       1986010119960101        N                           
E023600100PPUMP FOR WATER CIRCULATING PAD                                                  Pump for water circulating p36      A60-9                                                                                                 D                          D1E R       1986010119960101        N                           
E023800100PNON-ELECTRIC HEAT PAD, MOIST                                                    Heat pad non-electric moist 32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E023900100PHYDROCOLLATOR UNIT, PORTABLE                                                    Hydrocollator unit portable 32      A60-9              2210.3                                                                             D                          D1E APR     1986010119960101        N                           
E024000100PBATH/SHOWER CHAIR, WITH OR WITHOUT WHEELS, ANY SIZE                             Bath/shower chair           00      960-9                                                                                                 M                          D1E 9       2004010120060101        F                           
E024100100PBATH TUB WALL RAIL, EACH                                                        Bath tub wall rail          00      960-9              2100.1                                                                             M                          D1E APR     1986010119960101        N                           
E024200100PBATH TUB RAIL, FLOOR BASE                                                       Bath tub rail floor         00      960-9              2100.1                                                                             M                          D1E APR     1986010119960101        N                           
E024300100PTOILET RAIL, EACH                                                               Toilet rail                 00      960-9              2100.1                                                                             M                          D1E APR     1986010119960101        N                           
E024400100PRAISED TOILET SEAT                                                              Toilet seat raised          00      960-9                                                                                                 M                          D1E APR     1986010119960101        N                           
E024500100PTUB STOOL OR BENCH                                                              Tub stool or bench          00      960-9                                                                                                 M                          D1E APR     1986010119960101        N                           
E024600100PTRANSFER TUB RAIL ATTACHMENT                                                    Transfer tub rail attachment00      9                                                                                                     C                          D1E APR     1986010119960101        N                           
E024700100PTRANSFER BENCH FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING                Trans bench w/wo comm open  00      960-9                                                                                                 D                          D1E APR     2004010120040101        N                           
E024800100PTRANSFER BENCH, HEAVY DUTY, FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING   HDtrans bench w/wo comm open00      960-9                                                                                                 D                          D1E APR     2004010120040101        N                           
E024900100PPAD FOR WATER CIRCULATING HEAT UNIT                                             Pad water circulating heat u32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E025000100PHOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITH MATTRESS             Hosp bed fixed ht w/ mattres36      A60-18             2100.1                                                                             D                          D1B R       1986010119910101        N                           
E025100100PHOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS          Hosp bed fixd ht w/o mattres36      A60-18             2100.1                                                                             D                          D1B R       1986010119910101        N                           
E025500100PHOSPITAL 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       1986010119910101        N                           
E025600100PHOSPITAL 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       1991010119910101        N                           
E026000100PHOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE      Hosp bed semi-electr w/ matt36      A60-18             2100.1                                                                             D                          D1B R       1986010119910101        N                           
E026000200QRAILS, WITH MATTRESS                                                                                                                                                                                                                                                                                                 
E026100100PHOSPITAL 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       1991010119910101        N                           
E026100200QRAILS, WITHOUT MATTRESS                                                                                                                                                                                                                                                                                              
E026500100PHOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE Hosp bed total electr w/ mat36      A60-18             2100.1                                                                             D                          D1B R       1986010119910101        N                           
E026500200QSIDE RAILS, WITH MATTRESS                                                                                                                                                                                                                                                                                            
E026600100PHOSPITAL 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       1986010119910101        N                           
E026600200QSIDE RAILS, WITHOUT MATTRESS                                                                                                                                                                                                                                                                                         
E027000100PHOSPITAL BED, INSTITUTIONAL TYPE INCLUDES: OSCILLATING, CIRCULATING AND STRYKER Hospital bed institutional t00      960-9                                                                                                 M                          D1B R       1986010119930101        N                           
E027000200QFRAME, WITH MATTRESS                                                                                                                                                                                                                                                                                                 
E027100100PMATTRESS, INNERSPRING                                                           Mattress innerspring        32      A60-18 60-9                                                                                           D                          D1B APR     1986010119930101        N                           
E027200100PMATTRESS, FOAM RUBBER                                                           Mattress foam rubber        32      A60-18 60-9                                                                                           D                          D1B APR     1986010119930101        N                           
E027300100PBED BOARD                                                                       Bed board                   00      960-9                                                                                                 M                          D1B APR     1986010119890101        N                           
E027400100POVER-BED TABLE                                                                  Over-bed table              00      960-9                                                                                                 M                          D1B APR     1986010119890101        N                           
E027500100PBED PAN, STANDARD, METAL OR PLASTIC                                             Bed pan standard            32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E027600100PBED PAN, FRACTURE, METAL OR PLASTIC                                             Bed pan fracture            32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E027700100PPOWERED PRESSURE-REDUCING AIR MATTRESS                                          Powered pres-redu air mattrs36      A60-9                                                                                                 D                          D1E R       1992010119980101        N                           
E028000100PBED CRADLE, ANY TYPE                                                            Bed cradle                  32      A                                                                                                     C                          D1B APR     1986010119890101        N                           
E029000100PHOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITH MATTRESS                   Hosp bed fx ht w/o rails w/m36      A60-18             2100.1                                                                             D                          D1B R       1991010119910101        N                           
E029100100PHOSPITAL 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       1991010119910101        N                           
E029200100PHOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITH MATTRESS         Hosp bed var ht w/o rail w/o36      A60-18             2100.1                                                                             D                          D1B R       1991010119910101        N                           
E029300100PHOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITHOUT MATTRESS      Hosp bed var ht w/o rail w/ 36      A60-18             2100.1                                                                             D                          D1B R       1991010119910101        N                           
E029400100PHOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS,     Hosp bed semi-elect w/ mattr36      A60-18             2100.1                                                                             D                          D1B R       1991010119910101        N                           
E029400200QWITH MATTRESS                                                                                                                                                                                                                                                                                                        
E029500100PHOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS,     Hosp bed semi-elect w/o matt36      A60-18             2100.1                                                                             D                          D1B R       1991010119910101        N                           
E029500200QWITHOUT MATTRESS                                                                                                                                                                                                                                                                                                     
E029600100PHOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS). WITHOUT SIDE  Hosp bed total elect w/ matt36      A60-18             2100.1                                                                             D                          D1B R       1991010119920101        N                           
E029600200QRAILS, WITH MATTRESS                                                                                                                                                                                                                                                                                                 
E029700100PHOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITHOUT SIDE  Hosp bed total elect w/o mat36      A60-18             2100.1                                                                             D                          D1B R       1991010119910101        N                           
E029700200QRAILS, WITHOUT MATTRESS                                                                                                                                                                                                                                                                                              
E030000100PPEDIATRIC CRIB, HOSPITAL GRADE, FULLY ENCLOSED                                  Enclosed ped crib hosp grade32      A                                                                                                     C                          D1B APR     2004010120040101        N                           
E030100100PHOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350     HD hosp bed, 350-600 lbs    36      A60-18                                                                                                D                          D1B R       2004010120040101        N                           
E030100200QPOUNDS, BUT LESS THAN OR EQUAL TO 600 POUNDS, WITH ANY TYPE SIDE RAILS, WITHOUT                                                                                                                                                                                                                                      
E030100300QMATTRESS                                                                                                                                                                                                                                                                                                             
E030200100PHOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN   Ex hd hosp bed > 600 lbs    36      A60-18                                                                                                D                          D1B R       2004010120040101        N                           
E030200200Q600 POUNDS, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS                                                                                                                                                                                                                                                               
E030300100PHOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350     Hosp bed hvy dty xtra wide  36      A60-18                                                                                                D                          D1B R       2004010120040101        N                           
E030300200QPOUNDS, BUT LESS THAN OR EQUAL TO 600 POUNDS, WITH ANY TYPE SIDE RAILS, WITH                                                                                                                                                                                                                                         
E030300300QMATTRESS                                                                                                                                                                                                                                                                                                             
E030400100PHOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN   Hosp bed xtra hvy dty x wide36      A60-18                                                                                                D                          D1B R       2004010120040101        N                           
E030400200Q600 POUNDS, WITH ANY TYPE SIDE RAILS, WITH MATTRESS                                                                                                                                                                                                                                                                  
E030500100PBED SIDE RAILS, HALF LENGTH                                                     Rails bed side half length  36      A60-18                                                                                                D                          D1B R       1986010119900101        N                           
E031000100PBED SIDE RAILS, FULL LENGTH                                                     Rails bed side full length  32      A60-18                                                                                                D                          D1B APR     1986010119900101        N                           
E031500100PBED ACCESSORY: BOARD, TABLE, OR SUPPORT DEVICE, ANY TYPE                        Bed accessory brd/tbl/supprt00      960-9                                                                                                 M                          D1B APR     1986010119970101        N                           
E031600100PSAFETY ENCLOSURE FRAME/CANOPY FOR USE WITH HOSPITAL BED, ANY TYPE               Bed safety enclosure        36      A                                                                                                     C                          D1B APR     2002010120020101        N                           
E032500100PURINAL; MALE, JUG-TYPE, ANY MATERIAL                                            Urinal male jug-type        32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E032600100PURINAL; FEMALE, JUG-TYPE, ANY MATERIAL                                          Urinal female jug-type      32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E035000100PCONTROL UNIT FOR ELECTRONIC BOWEL IRRIGATION/EVACUATION SYSTEM                  Control unit bowel system   57      A                                                                                                     C                          Z2  9       1995010119950101        N                           
E035200100PDISPOSABLE PACK (WATER RESERVOIR BAG, SPECULUM, VALVING MECHANISM AND           Disposable pack w/bowel syst57      A                                                                                                     C                          Z2  9       1995010119950101        N                           
E035200200QCOLLECTION BAG/BOX) FOR USE WITH THE ELECTRONIC BOWEL IRRIGATION/EVACUATION                                                                                                                                                                                                                                          
E035200300QSYSTEM                                                                                                                                                                                                                                                                                                               
E037000100PAIR PRESSURE  ELEVATOR FOR HEEL                                                 Air elevator for heel       00      9                                                                                                     C                          D1E APR     1997010119980101        N                           
E037100100PNONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS   Nonpower mattress overlay   36      A                                                                                                     C                          D1E APR     1998010119980101        N                           
E037100200QLENGTH AND WIDTH                                                                                                                                                                                                                                                                                                     
E037200100PPOWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH            Powered air mattress overlay36      A                                                                                                     C                          D1E APR     1998010119980101        N                           
E037300100PNONPOWERED ADVANCED PRESSURE REDUCING MATTRESS                                  Nonpowered pressure mattress36      A                                                                                                     C                          D1E APR     1998010119980101        N                           
E042400100PSTATIONARY COMPRESSED GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER,        Stationary compressed gas 0233      A60-4              4107.9                                                                             D                          D1C R       1993010120010101        N                           
E042400200QCONTENTS, REGULATOR, FLOWMETER, HUMIDIFIER, NEBULIZER, CANNULA OR MASK, AND                                                                                                                                                                                                                                          
E042400300QTUBING                                                                                                                                                                                                                                                                                                               
E042500100PSTATIONARY COMPRESSED GAS SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER,      Gas system stationary compre00      960-4              4107.9                                                                             D                          D1C R       1986010119930101        N                           
E042500200QHUMIDIFIER, NEBULIZER, CANNULA OR MASK, AND TUBING                                                                                                                                                                                                                                                                   
E043000100PPORTABLE GASEOUS OXYGEN SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER,        Oxygen system gas portable  00      960-4              4107.9                                                                             D                          D1C R       1986010119930101        N                           
E043000200QHUMIDIFIER, CANNULA OR MASK, AND TUBING                                                                                                                                                                                                                                                                              
E043100100PPORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, Portable gaseous 02         33      A60-4              4107.9                                                                             D                          D1C R       1993010120010101        N                           
E043100200QFLOWMETER, HUMIDIFIER, CANNULA OR MASK, AND TUBING                                                                                                                                                                                                                                                                   
E043400100PPORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, SUPPLY      Portable liquid 02          33      A60-4              4107.9                                                                             D                          D1C R       1993010119930101        N                           
E043400200QRESERVOIR, HUMIDIFIER, FLOWMETER, REFILL ADAPTOR, CONTENTS GAUGE, CANNULA OR                                                                                                                                                                                                                                         
E043400300QMASK, AND TUBING                                                                                                                                                                                                                                                                                                     
E043500100PPORTABLE LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES PORTABLE CONTAINER, SUPPLY    Oxygen system liquid portabl00      960-4              4107.9                                                                             D                          D1C R       1986010119930101        N                           
E043500200QRESERVOIR, FLOWMETER, HUMIDIFIER, CONTENTS GAUGE, CANNULA OR MASK, TUBING AND                                                                                                                                                                                                                                        
E043500300QREFILL ADAPTOR                                                                                                                                                                                                                                                                                                       
E043900100PSTATIONARY LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER, CONTENTS,          Stationary liquid 02        33      A60-4              4107.9                                                                             D                          D1C R       1993010120010101        N                           
E043900200QREGULATOR, FLOWMETER, HUMIDIFIER, NEBULIZER, CANNULA OR MASK, & TUBING                                                                                                                                                                                                                                               
E044000100PSTATIONARY LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES USE OF RESERVOIR, CONTENTS  Oxygen system liquid station00      960-4              4107.9                                                                             D                          D1C R       1986010119930101        N                           
E044000200QINDICATOR, REGULATOR, FLOWMETER, HUMIDIFIER, NEBULIZER, CANNULA OR MASK, AND                                                                                                                                                                                                                                         
E044000300QTUBING                                                                                                                                                                                                                                                                                                               
E044100100POXYGEN CONTENTS, GASEOUS (FOR USE WITH OWNED GASEOUS STATIONARY SYSTEMS OR WHEN Oxygen contents, gaseous    33      A60-4              4107.9                                                                             D                          D1C P       1993010120030101        N                           
E044100200QBOTH A STATIONARY AND PORTABLE GASEOUS SYSTEM ARE OWNED), 1 MONTH'S SUPPLY = 1                                                                                                                                                                                                                                       
E044100300QUNIT                                                                                                                                                                                                                                                                                                                 
E044200100POXYGEN CONTENTS, LIQUID (FOR USE WITH OWNED LIQUID STATIONARY SYSTEMS OR WHEN   Oxygen contents, liquid     33      A60-4              4107.9                                                                             D                          D1C P       1993010120030101        N                           
E044200200QBOTH A STATIONARY AND PORTABLE LIQUID SYSTEM ARE OWNED), 1 MONTH'S SUPPLY = 1                                                                                                                                                                                                                                        
E044200300QUNIT                                                                                                                                                                                                                                                                                                                 
E044300100PPORTABLE OXYGEN CONTENTS, GASEOUS (FOR USE ONLY WITH PORTABLE GASEOUS SYSTEMS   Portable 02 contents, gas   33      A60-4              4107.9                                                                             D                          D1C P       1993010120030101        N                           
E044300200QWHEN NO STATIONARY GAS OR LIQUID SYSTEM IS USED), 1 MONTH'S SUPPLY = 1 UNIT                                                                                                                                                                                                                                          
E044400100PPORTABLE OXYGEN CONTENTS, LIQUID (FOR USE ONLY WITH PORTABLE LIQUID SYSTEMS     Portable 02 contents, liquid33      A60-4              4107.9                                                                             D                          D1C P       1993010120030101        N                           
E044400200QWHEN NO STATIONARY GAS OR LIQUID SYSTEM IS USED), 1 MONTH'S SUPPLY = 1 UNIT                                                                                                                                                                                                                                          
E044500100POXIMETER DEVICE FOR MEASURING BLOOD OXYGEN LEVELS NON-INVASIVELY                Oximeter non-invasive       00      9                                                                                                     C                          Z2  9       2003010120030101        N                           
E045000100PVOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE  Vol control vent invasiv int31      A60-9                                                                                                 D                          D1E R       1985010120050101        N                           
E045000200QCONTROL MODE, USED WITH INVASIVE INTERFACE (E.G., TRACHEOSTOMY TUBE)                                                                                                                                                                                                                                                 
E045400100PPRESSURE VENTILATOR WITH PRESSURE CONTROL, PRESSURE SUPPORT AND FLOW TRIGGERING Pressure ventilator         31      A60-9                                                                                                 D                          D1E R       200301012005010120041231N                           
E045400200QFEATURES                                                                                                                                                                                                                                                                                                             
E045500100POXYGEN TENT, EXCLUDING CROUP OR PEDIATRIC TENTS                                 Oxygen tent excl croup/ped t33      A60-4              4107.9                                                                             D                          D1C R       1986010119900101        N                           
E045700100PCHEST SHELL (CUIRASS)                                                           Chest shell                 32      A                                                                                                     C                          D1E APR     1990010120010101        N                           
E045900100PCHEST WRAP                                                                      Chest wrap                  36      A                                                                                                     C                          D1E R       1990010119960101        N                           
E046000100PNEGATIVE PRESSURE VENTILATOR;  PORTABLE OR STATIONARY                           Neg press vent portabl/statn31      A60-9                                                                                                 D                          D1E R       1990010119960101        N                           
E046100100PVOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE  Vol control vent noninv int 31      A60-9                                                                                                 D                          D1E R       2003010120050101        N                           
E046100200QCONTROL MODE,  USED WITH NON-INVASIVE INTERFACE (E.G. MASK)                                                                                                                                                                                                                                                          
E046200100PROCKING BED WITH OR WITHOUT SIDE RAILS                                          Rocking bed w/ or w/o side r36      A                                                                                                     C                          D1B R       1990010119960101        N                           
E046300100PPRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE      Press supp vent invasive int31      A                                                                                                     C                          D1E R       2005010120050101        P                           
E046300200QCONTROL MODE, USED WITH INVASIVE INTERFACE (E.G. TRACHEOSTOMY TUBE)                                                                                                                                                                                                                                                  
E046400100PPRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE      Press supp vent noninv int  31      A                                                                                                     C                          D1E R       2005010120050101        P                           
E046400200QCONTROL MODE, USED WITH NON-INVASIVE INTERFACE (E.G. MASK)                                                                                                                                                                                                                                                           
E047000100PRESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE    RAD w/o backup non-inv intfc36      A60-9                                                                                                 D                          D1E R       2004010120040101        N                           
E047000200QFEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK                                                                                                                                                                                                                                                 
E047000300Q(INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                         
E047100100PRESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE      RAD w/backup non inv intrfc 31      A60-9                                                                                                 D                          D1E R       2004010120040101        N                           
E047100200QFEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK                                                                                                                                                                                                                                                 
E047100300Q(INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                         
E047200100PRESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACKUP RATE       RAD w backup invasive intrfc31      A60-9                                                                                                 D                          D1E R       2004010120040101        N                           
E047200200QFEATURE, USED WITH INVASIVE INTERFACE, E.G., TRACHEOSTOMY TUBE (INTERMITTENT                                                                                                                                                                                                                                         
E047200300QASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                                       
E048000100PPERCUSSOR, ELECTRIC OR PNEUMATIC, HOME MODEL                                    Percussor elect/pneum home m36      A60-9                                                                                                 D                          D1E R       1986010119960101        N                           
E048100100PINTRAPULMONARY PERCUSSIVE VENTILATION SYSTEM AND RELATED ACCESSORIES            Intrpulmnry percuss vent sys00      960-21                                                                                                M                          D1E APR     2002010120020701        N                           
E048200100PCOUGH STIMULATING DEVICE, ALTERNATING POSITIVE AND NEGATIVE AIRWAY PRESSURE     Cough stimulating device    36      A                                                                                                     C                          D1E R       2002010120020101        N                           
E048300100PHIGH FREQUENCY CHEST WALL OSCILLATION AIR-PULSE GENERATOR SYSTEM, (INCLUDES     Chest compression gen system36      A                                                                                                     C                          D1E R       2003010120030101        N                           
E048300200QHOSES AND VEST), EACH                                                                                                                                                                                                                                                                                                
E048400100POSCILLATORY POSITIVE EXPIRATORY PRESSURE DEVICE, NON-ELECTRIC, ANY TYPE, EACH   Non-elec oscillatory pep dvc32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
E048500100PORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR Oral device/appliance prefab32      A                                                                                                     C                          D1E P       2006010120060101        A                           
E048500200QNON-ADJUSTABLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
E048600100PORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR Oral device/appliance cusfab32      A                                                                                                     C                          D1E P       2006010120060101        A                           
E048600200QNON-ADJUSTABLE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                   
E050000100PIPPB MACHINE,  ALL TYPES, WITH BUILT-IN NEBULIZATION; MANUAL OR AUTOMATIC       Ippb all types              31      A60-9                                                                                                 D                          D1E R       1986010119960101        N                           
E050000200QVALVES; INTERNAL OR EXTERNAL POWER SOURCE                                                                                                                                                                                                                                                                            
E055000100PHUMIDIFIER, DURABLE FOR EXTENSIVE SUPPLEMENTAL HUMIDIFICATION DURING IPPB       Humidif extens supple w ippb33      A60-9                                                                                                 D                          D1E R       1986010120050701        P                           
E055000200QTREATMENTS OR OXYGEN DELIVERY                                                                                                                                                                                                                                                                                        
E055500100PHUMIDIFIER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC BOTTLE TYPE, FOR USE WITH    Humidifier for use w/ regula33      A60-9              4107.9                                                                             D                          D1C PR      1986010119960101        N                           
E055500200QREGULATOR OR FLOWMETER                                                                                                                                                                                                                                                                                               
E056000100PHUMIDIFIER, DURABLE FOR SUPPLEMENTAL HUMIDIFICATION DURING IPPB TREATMENT OR    Humidifier supplemental w/ i33      A60-9                                                                                                 D                          D1E APR     1986010120050701        P                           
E056000200QOXYGEN DELIVERY                                                                                                                                                                                                                                                                                                      
E056100100PHUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE               Humidifier nonheated w PAP  32      A                                                                                                     C                          D1E APR     2004010120040101        N                           
E056200100PHUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE                   Humidifier heated used w PAP32      A                                                                                                     C                          D1E APR     2004010120040101        N                           
E056500100PCOMPRESSOR, AIR POWER SOURCE FOR EQUIPMENT WHICH IS NOT SELF- CONTAINED OR      Compressor air power source 36      A                                                                                                     C                          D1E R       1982010119960101        N                           
E056500200QCYLINDER DRIVEN                                                                                                                                                                                                                                                                                                      
E057000100PNEBULIZER, WITH COMPRESSOR                                                      Nebulizer with compression  36      A60-9              4107.9                                                                             D                          D1E R       1986010119960101        N                           
E057100100PAEROSOL COMPRESSOR, BATTERY POWERED, FOR USE WITH SMALL VOLUME NEBULIZER        Aerosol compressor for svneb36      A60-9                                                                                                 D                          D1E APR     2001010120010101        N                           
E057200100PAEROSOL COMPRESSOR, ADJUSTABLE PRESSURE, LIGHT DUTY FOR INTERMITTENT USE        Aerosol compressor adjust pr36      A                                                                                                     C                          D1E APR     2001010120010101        N                           
E057400100PULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER             Ultrasonic generator w svneb36      A                                                                                                     C                          D1E APR     2001010120030101        N                           
E057500100PNEBULIZER, ULTRASONIC, LARGE VOLUME                                             Nebulizer ultrasonic        31      A60-9                                                                                                 D                          D1E R       1986010120010101        N                           
E058000100PNEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, FOR USE WITH    Nebulizer for use w/ regulat32      A60-9              4107.9                                                                             D                          D1E PR      1986010119980101        N                           
E058000200QREGULATOR OR FLOWMETER                                                                                                                                                                                                                                                                                               
E058500100PNEBULIZER, WITH COMPRESSOR AND HEATER                                           Nebulizer w/ compressor & he36      A60-9              4107.9                                                                             D                          D1E R       1986010119960101        N                           
E059000100PDISPENSING FEE COVERED DRUG ADMINISTERED THROUGH DME NEBULIZER                  Dispensing fee dme neb drug 46      A                                                                                                     C                          D1G 9       200001012006010120051231D                           
E060000100PRESPIRATORY SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC          Suction pump portab hom modl36      A60-9                                                                                                 D                          D1E R       1986010120020101        N                           
E060100100PCONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE                                        Cont airway pressure device 36      A60-17                                                                                                D                          D1E R       1988010119960101        N                           
E060200100PBREAST PUMP, MANUAL, ANY TYPE                                                   Manual breast pump          32      A                                                                                                     C                          D1E 9       2000010120020101        N                           
E060300100PBREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE                                  Electric breast pump        00      9                                                                                                     C                          Z2  9       2002010120020101        N                           
E060400100PBREAST PUMP, HEAVY DUTY, HOSPITAL GRADE, PISTON OPERATED, PULSATILE VACUUM      Hosp grade elec breast pump 00      9                                                                                                     C                          Z2  9       2002010120020101        N                           
E060400200QSUCTION/RELEASE CYCLES, VACUUM REGULATOR, SUPPLIES, TRANSFORMER, ELECTRIC (AC                                                                                                                                                                                                                                        
E060400300QAND / OR DC)                                                                                                                                                                                                                                                                                                         
E060500100PVAPORIZER, ROOM TYPE                                                            Vaporizer room type         32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E060600100PPOSTURAL DRAINAGE BOARD                                                         Drainage board postural     36      A60-9                                                                                                 D                          D1E R       1986010119960101        N                           
E060700100PHOME BLOOD GLUCOSE MONITOR                                                      Blood glucose monitor home  32      A60-11                                                                                                D                          D1E APR     1986010119960101        N                           
E060800100PAPNEA MONITOR                                                                   Apnea monitor               36      A60-17                                                                       E0618                    D                          D1E R       198601012003010120021231N                           
E061000100PPACEMAKER MONITOR, SELF-CONTAINED, (CHECKS BATTERY DEPLETION, INCLUDES AUDIBLE  Pacemaker monitr audible/vis32      A60-7  50-1                                                                                           D                          D1E APR     1986010119960101        N                           
E061000200QAND VISIBLE CHECK SYSTEMS)                                                                                                                                                                                                                                                                                           
E061500100PPACEMAKER MONITOR, SELF CONTAINED, CHECKS BATTERY DEPLETION AND OTHER PACEMAKER Pacemaker monitr digital/vis32      A60-7  50-1                                                                                           D                          D1E APR     1986010119960101        N                           
E061500200QCOMPONENTS, INCLUDES DIGITAL/VISIBLE CHECK SYSTEMS                                                                                                                                                                                                                                                                   
E061600100PIMPLANTABLE CARDIAC EVENT RECORDER WITH MEMORY, ACTIVATOR AND PROGRAMMER        Cardiac event recorder      00      9                                                                                                     C                          D1E 9       2000010120050401        P                           
E061700100PEXTERNAL DEFIBRILLATOR WITH INTEGRATED ELECTROCARDIOGRAM ANALYSIS               Automatic ext defibrillator 36      A                                                                                                     C                          D1E 9R      2001010120010101        N                           
E061800100PAPNEA MONITOR, WITHOUT RECORDING FEATURE                                        Apnea monitor               00      9                                                                                                     C                          D1E R       2003010120030101        N                           
E061900100PAPNEA MONITOR, WITH RECORDING FEATURE                                           Apnea monitor w recorder    00      9                                                                                                     C                          D1E R       2003010120030101        N                           
E062000100PSKIN PIERCING DEVICE FOR COLLECTION OF CAPILLARY BLOOD, LASER, EACH             Cap bld skin piercing laser 32      A                                                                                                     C                          D1E APR     2002010120020101        N                           
E062100100PSLING OR SEAT, PATIENT LIFT, CANVAS OR NYLON                                    Patient lift sling or seat  32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E062500100PPATIENT LIFT, BATHROOM OR TOILET, NOT OTHERWISE CLASSIFIED                      Patient lift bathroom or toi00      960-9                                                                                                 M                          D1E APR     1986010120050101        N                           
E062700100PSEAT LIFT MECHANISM INCORPORATED INTO A COMBINATION LIFT-CHAIR MECHANISM        Seat lift incorp lift-chair 32      A60-8              4107.8                                                    Q0080                    D                          D1E APR     1992010119960101        N                           
E062800100PSEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-ELECTRIC      Seat lift for pt furn-electr32      A60-8              4107.8                                                    Q0078                    D                          D1E APR     1992010119960101        N                           
E062900100PSEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-NON-ELECTRIC  Seat lift for pt furn-non-el32      A                  4107.8                                                    Q0079                    D                          D1E APR     1992010119960101        N                           
E063000100PPATIENT LIFT, HYDRAULIC, WITH SEAT OR SLING                                     Patient lift hydraulic      36      A60-9                                                                                                 D                          D1E R       1986010119960101        N                           
E063500100PPATIENT LIFT, ELECTRIC WITH SEAT OR SLING                                       Patient lift electric       36      A60-9                                                                                                 D                          D1E R       1986010119960101        N                           
E063600100PMULTIPOSITIONAL PATIENT SUPPORT SYSTEM, WITH INTEGRATED LIFT, PATIENT           PT support & positioning sys36      A                                                                                                     C                          D1E R       2003010120030101        N                           
E063600200QACCESSIBLE CONTROLS                                                                                                                                                                                                                                                                                                  
E063700100PCOMBINATION SIT TO STAND SYSTEM, ANY SIZE INCLUDING PEDIATRIC, WITH SEATLIFT    Combination sit to stand sys32      A60-9                                                                                                 D                          D1E APR     2004010120060101        C                           
E063700200QFEATURE, WITH OR WITHOUT WHEELS                                                                                                                                                                                                                                                                                      
E063800100PSTANDING FRAME SYSTEM, ONE POSITION (E.G. UPRIGHT, SUPINE OR PRONE STANDER),    Standing frame sys          00      960-9                                                                                                 M                          D1E APR     2004010120060101        C                           
E063800200QANY SIZE INCLUDING PEDIATRIC, WITH OR WITHOUT WHEELS                                                                                                                                                                                                                                                                 
E063900100PPATIENT LIFT, MOVEABLE FROM ROOM TO ROOM WITH DISASSEMBLY AND REASSEMBLY,       Moveable patient lift system00      9                                                                                                     I                          Y2  9       2005010120050101        N                           
E063900200QINCLUDES ALL COMPONENTS/ACCESSORIES                                                                                                                                                                                                                                                                                  
E064000100PPATIENT LIFT, FIXED SYSTEM, INCLUDES ALL COMPONENTS/ACCESSORIES                 Fixed patient lift system   00      9                                                                                                     I                          Y2  9       2005010120050101        N                           
E064100100PSTANDING FRAME SYSTEM, MULTI-POSITION (E.G. THREE-WAY STANDER), ANY SIZE        Multi-position stnd fram sys00      960-9                                                                                                 M                          D1E APR     2006010120060101        A                           
E064100200QINCLUDING PEDIATRIC, WITH OR WITHOUT WHEELS                                                                                                                                                                                                                                                                          
E064200100PSTANDING FRAME SYSTEM, MOBILE (DYNAMIC STANDER), ANY SIZE INCLUDING PEDIATRIC   Dynamic standing frame      00      960-9                                                                                                 M                          D1E APR     2006010120060101        A                           
E065000100PPNEUMATIC COMPRESSOR, NON-SEGMENTAL HOME MODEL                                  Pneuma compresor non-segment32      A60-16                                                                                                D                          D1E APR     1986010119960101        N                           
E065100100PPNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITHOUT CALIBRATED GRADIENT PRESSURE Pneum compressor segmental  32      A60-16                                                                                                D                          D1E APR     1988010119960101        N                           
E065200100PPNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITH CALIBRATED GRADIENT PRESSURE    Pneum compres w/cal pressure32      A60-16                                                                                                D                          D1E APR     1988010119960101        N                           
E065500100PNON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF ARM   Pneumatic appliance half arm32      A60-16                                                                                                D                          D1E APR     1986010119960101        N                           
E066000100PNON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG   Pneumatic appliance full leg32      A60-16                                                                                                D                          D1E APR     1986010119960101        N                           
E066500100PNON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM   Pneumatic appliance full arm32      A60-16                                                                                                D                          D1E APR     1986010119960101        N                           
E066600100PNON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG   Pneumatic appliance half leg32      A60-16                                                                                                D                          D1E APR     1986010119960101        N                           
E066700100PSEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG       Seg pneumatic appl full leg 32      A60-16                                                                                                D                          D1E APR     1988010119960101        N                           
E066800100PSEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM       Seg pneumatic appl full arm 32      A60-16                                                                                                D                          D1E APR     1988010119960101        N                           
E066900100PSEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG       Seg pneumatic appli half leg32      A60-16                                                                                                D                          D1E APR     1994010119940101        N                           
E067100100PSEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL LEG                       Pressure pneum appl full leg32      A60-16                                                                                                D                          D1E APR     1995010119950101        N                           
E067200100PSEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL ARM                       Pressure pneum appl full arm32      A60-16                                                                                                D                          D1E APR     1995010119950101        N                           
E067300100PSEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, HALF LEG                       Pressure pneum appl half leg32      A60-16                                                                                                D                          D1E APR     1995010119950101        N                           
E067500100PPNEUMATIC COMPRESSION DEVICE, HIGH PRESSURE, RAPID INFLATION/DEFLATION CYCLE,   Pneumatic compression device36      A                                                                                                     C                          D1E R       2004010120040101        N                           
E067500200QFOR ARTERIAL INSUFFICIENCY (UNILATERAL OR BILATERAL SYSTEM)                                                                                                                                                                                                                                                          
E069000100PULTRAVIOLET CABINET, APPROPRIATE FOR HOME USE                                   Ultraviolet cabinet         32      A60-9                                                                                                 D                          D1E APR     198601012003010120021231N                           
E069100100PULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE     Uvl pnl 2 sq ft or less     32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
E069100200QPROTECTION; TREATMENT AREA 2 SQUARE FEET OR LESS                                                                                                                                                                                                                                                                     
E069200100PULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE     Uvl sys panel 4 ft          32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
E069200200QPROTECTION, 4 FOOT PANEL                                                                                                                                                                                                                                                                                             
E069300100PULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE     Uvl sys panel 6 ft          32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
E069300200QPROTECTION, 6 FOOT PANEL                                                                                                                                                                                                                                                                                             
E069400100PULTRAVIOLET MULTIDIRECTIONAL LIGHT THERAPY SYSTEM IN 6 FOOT CABINET, INCLUDES   Uvl md cabinet sys 6 ft     32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
E069400200QBULBS/LAMPS, TIMER AND EYE PROTECTION                                                                                                                                                                                                                                                                                
E070000100PSAFETY EQUIPMENT (E.G., BELT, HARNESS OR VEST)                                  Safety equipment            00      9                                                                                                     C                          D1E APR     1986010119960101        N                           
E070100100PHELMET WITH FACE GUARD AND SOFT INTERFACE MATERIAL, PREFABRICATED               Helmet w face guard prefab  32      A                                                                                                     C                          D1E APR     2003010120030101        N                           
E070500100PTRANSFER BOARD OR DEVICE, ANY TYPE, EACH                                        Transfer board or device    00      9                                                                                                     D                      0125Z2  APR     2006010120060101        A                           
E071000100PRESTRAINTS, ANY TYPE (BODY, CHEST, WRIST OR ANKLE)                              Restraints any type         57      A                                                                                                     C                          Z2  APR     1986010119960101        N                           
E072000100PTENS, TWO LEAD, LOCALIZED STIMULATION                                           Tens two lead               32      A35-20 35-46       4107.6                                                                             D                          D1E APR     1986010119960101        N                           
E073000100PTRANSCUTANEOUS ELECTRICAL NERVE STIMULATION DEVICE, FOUR OR MORE LEADS, FOR     Tens four lead              32      A35-20 35-46       4107.6                                                                             D                          D1E APR     1986010120030101        N                           
E073000200QMULTIPLE NERVE STIMULATION                                                                                                                                                                                                                                                                                           
E073100100PFORM FITTING CONDUCTIVE GARMENT FOR DELIVERY OF TENS OR NMES (WITH CONDUCTIVE   Conductive garment for tens/34      A45-25                                                                                                D                          D1E APR     1989010119960101        N                           
E073100200QFIBERS SEPARATED FROM THE PATIENT'S SKIN BY LAYERS OF FABRIC)                                                                                                                                                                                                                                                        
E074000100PINCONTINENCE TREATMENT SYSTEM, PELVIC FLOOR STIMULATOR, MONITOR, SENSOR AND/OR  Incontinence treatment systm32      A60.24                                                                                                D                          D1E APR     1986010120010401        N                           
E074000200QTRAINER                                                                                                                                                                                                                                                                                                              
E074400100PNEUROMUSCULAR STIMULATOR FOR SCOLIOSIS                                          Neuromuscular stim for scoli36      A                                                                                                     C                          D1E R       1989010119960101        N                           
E074500100PNEUROMUSCULAR STIMULATOR, ELECTRONIC SHOCK UNIT                                 Neuromuscular stim for shock36      A35-77                                                                                                D                          D1E R       1986010119960101        N                           
E074600100PELECTROMYOGRAPHY (EMG), BIOFEEDBACK DEVICE                                      Electromyograph biofeedback 52      A35-27                                                                                                D                          D1E APR     1989010119960101        N                           
E074700100POSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, OTHER THAN SPINAL            Elec osteogen stim not spine32      A35-48                                                                                                D                          D1E APR     1986010119970101        N                           
E074700200QAPPLICATIONS                                                                                                                                                                                                                                                                                                         
E074800100POSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, SPINAL APPLICATIONS          Elec osteogen stim spinal   32      A35-48                                                                                                D                          D1E APR     1996010119970101        N                           
E074900100POSTEOGENESIS STIMULATOR, ELECTRICAL, SURGICALLY IMPLANTED                       Elec osteogen stim implanted36      A35-48                                                                                                D                          D1E 9       1986010120000701        N                           
E075200100PIMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH                                     Neurostimulator electrode   38      A                  65-8                                                      L8680                    D                          D1F P       200201012006010120051231D                           
E075400100PPATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE             Pulsegenerator pt programmer38      A65-8                                                                        L8681                    D                          D1F P       200201012006010120051231D                           
E075400200QNEUROSTIMULATOR PULSE GENERATOR                                                                                                                                                                                                                                                                                      
E075500100PELECTRONIC SALIVARY REFLEX STIMULATOR (INTRA-ORAL/NON-INVASIVE)                 Electronic salivary reflex s52      A                                                                                                     C                          Z2  APR     1990010119950401        N                           
E075600100PIMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR                                     Implantable pulse generator 38      A65-8                                                                                                 D                          D1F P       200101012006010120051231D                           
E075700100PIMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER                             Implantable RF receiver     38      A65-8                                                                        L8682                    D                          D1F P       200101012006010120051231D                           
E075800100PRADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR  External RF transmitter     38      A65-8                                                                        L8683                    D                          D1F P       200101012006010120051231D                           
E075800200QRADIOFREQUENCY RECEIVER                                                                                                                                                                                                                                                                                              
E075900100PRADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT      Replace rdfrquncy transmittr38      A                                                                            L8684                    C                          D1F P       200201012006010120051231D                           
E075900200QNEUROSTIMULATOR RECEIVER FOR BOWEL AND BLADDER MANAGEMENT, REPLACEMENT                                                                                                                                                                                                                                               
E076000100POSTEOGENESIS STIMULATOR, LOW INTENSITY ULTRASOUND, NON-INVASIVE                 Osteogen ultrasound stimltor32      A                  35-48                                                                              C                          D1E APR     1997010120010101        N                           
E076100100PNON-THERMAL PULSED HIGH FREQUENCY RADIOWAVES, HIGH PEAK POWER ELECTROMAGNETIC   Nontherm electromgntc device00      935-102                                                                                               D                          D1E 9       2003010120050101        F                           
E076100200QENERGY TREATMENT DEVICE                                                                                                                                                                                                                                                                                              
E076200100PTRANSCUTANEOUS ELECTRICAL JOINT STIMULATION DEVICE SYSTEM, INCLUDES ALL         Trans elec jt stim dev sys  36      A                                                                                                     C                          D1E APR     2006010120060101        A                           
E076200200QACCESSORIES                                                                                                                                                                                                                                                                                                          
E076400100PFUNCTIONAL NEUROMUSCULAR STIMULATOR, TRANSCUTANEOUS STIMULATION OF MUSCLES OF   Functional neuromuscularstim32      A35-77                                                                                                D                          D1F APR     2006010120060101        A                           
E076400200QAMBULATION WITH COMPUTER CONTROL, USED FOR WALKING BY SPINAL CORD INJURED,                                                                                                                                                                                                                                           
E076400300QENTIRE SYSTEM, AFTER COMPLETION OF TRAINING PROGRAM                                                                                                                                                                                                                                                                  
E076500100PFDA APPROVED NERVE STIMULATOR, WITH REPLACEABLE BATTERIES, FOR TREATMENT OF     Nerve stimulator for tx n&v 32      A                                                                                                     C                          D1E AP      2001010120010101        N                           
E076500200QNAUSEA AND VOMITING                                                                                                                                                                                                                                                                                                  
E076900100PELECTRICAL STIMULATION OR ELECTROMAGNETIC WOUND TREATMENT DEVICE, NOT OTHERWISE Electric wound treatment dev00      935-102                                                                                               D                          Y2  9       2005010120050101        N                           
E076900200QCLASSIFIED                                                                                                                                                                                                                                                                                                           
E077600100PIV POLE                                                                         Iv pole                     32      A                                                                                                     C                          D1E AEPR    1985010119950401        N                           
E077900100PAMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION 8 HOURS OR GREATER Amb infusion pump mechanical36      A                                                                                                     C                          D1E APR     2000010120000101        N                           
E078000100PAMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION LESS THAN 8 HOURS  Mech amb infusion pump <8hrs32      A                                                                                                     C                          D1E APR     2000010120000101        N                           
E078100100PAMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE CHANNELS, ELECTRIC OR BATTERY      External ambulatory infus pu36      A60-14                                                                                                D                          D1E 9R      1987010120000701        N                           
E078100200QOPERATED, WITH ADMINISTRATIVE EQUIPMENT, WORN BY PATIENT                                                                                                                                                                                                                                                             
E078200100PINFUSION PUMP, IMPLANTABLE, NON-PROGRAMMABLE (INCLUDES ALL COMPONENTS, E.G.,    Non-programble infusion pump32      A60-14                                                                                                D                          D1E APR     1986010120030101        N                           
E078200200QPUMP, CATHETER, CONNECTORS, ETC.)                                                                                                                                                                                                                                                                                    
E078300100PINFUSION PUMP SYSTEM, IMPLANTABLE, PROGRAMMABLE (INCLUDES ALL COMPONENTS, E.G., Programmable infusion pump  32      A60-14                                                                                                D                          D1E APR     1995010119980101        N                           
E078300200QPUMP, CATHETER, CONNECTORS, ETC.)                                                                                                                                                                                                                                                                                    
E078400100PEXTERNAL AMBULATORY INFUSION PUMP, INSULIN                                      Ext amb infusn pump insulin 36      A60-14                                                                                                D                          D1E R       1996010120000701        N                           
E078500100PIMPLANTABLE INTRASPINAL (EPIDURAL/INTRATHECAL) CATHETER USED WITH IMPLANTABLE   Replacement impl pump cathet32      A                  60-14                                                                              D                          D1E P       1999010119990101        N                           
E078500200QINFUSION PUMP, REPLACEMENT                                                                                                                                                                                                                                                                                           
E078600100PIMPLANTABLE PROGRAMMABLE INFUSION PUMP, REPLACEMENT (EXCLUDES IMPLANTABLE       Implantable pump replacement32      A60-14                                                                                                D                          D1E 9       2001010120010101        N                           
E078600200QINTRASPINAL CATHETER)                                                                                                                                                                                                                                                                                                
E079100100PPARENTERAL INFUSION PUMP, STATIONARY, SINGLE OR MULTI-CHANNEL                   Parenteral infusion pump sta36      A65-10             2130    4450                                                                       D                          D1E R       1989010119960101        N                           
E083000100PAMBULATORY TRACTION DEVICE, ALL TYPES, EACH                                     Ambulatory traction device  00      960-9                                                                                                 D                          D1E P       2001010120010101        N                           
E084000100PTRACTION FRAME, ATTACHED TO HEADBOARD, CERVICAL TRACTION                        Tract frame attach headboard32      A60-9                                                                                                 D                          D1E APR     1984010119940101        N                           
E084900100PTRACTION EQUIPMENT, CERVICAL, FREE-STANDING STAND/FRAME, PNEUMATIC, APPLYING    Cervical pneum trac equip   32      A                                                                                                     C                          D1E APR     2005010120050101        N                           
E084900200QTRACTION FORCE TO OTHER THAN MANDIBLE                                                                                                                                                                                                                                                                                
E085000100PTRACTION STAND, FREE STANDING, CERVICAL TRACTION                                Traction stand free standing32      A60-9                                                                                                 D                          D1E APR     1982010119940101        N                           
E085500100PCERVICAL TRACTION EQUIPMENT NOT REQUIRING ADDITIONAL STAND OR FRAME             Cervical traction equipment 32      A                                                                                                     C                          D1E APR     1998010119980101        N                           
E086000100PTRACTION EQUIPMENT, OVERDOOR, CERVICAL                                          Tract equip cervical tract  32      A60-9                                                                                                 D                          D1E APR     1986010119890101        N                           
E087000100PTRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY TRACTION, (E.G. BUCK'S)        Tract frame attach footboard32      A60-9                                                                                                 D                          D1E APR     1986010119940101        N                           
E088000100PTRACTION STAND, FREE STANDING, EXTREMITY TRACTION, (E.G., BUCK'S)               Trac stand free stand extrem32      A60-9                                                                                                 D                          D1E APR     1986010119940101        N                           
E089000100PTRACTION FRAME, ATTACHED TO FOOTBOARD, PELVIC TRACTION                          Traction frame attach pelvic32      A60-9                                                                                                 D                          D1E APR     1986010119940101        N                           
E090000100PTRACTION STAND, FREE STANDING, PELVIC TRACTION, (E.G., BUCK'S)                  Trac stand free stand pelvic32      A60-9                                                                                                 D                          D1E APR     1986010119940101        N                           
E091000100PTRAPEZE BARS, A/K/A PATIENT HELPER, ATTACHED TO BED, WITH GRAB BAR              Trapeze bar attached to bed 36      A60-9                                                                                                 D                          D1E R       1986010119840101        N                           
E091100100PTRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS,   HD trapeze bar attach to bed36      A60-9                                                                                                 D                          D1B R       2006010120060101        A                           
E091100200QATTACHED TO BED, WITH GRAB BAR                                                                                                                                                                                                                                                                                       
E091200100PTRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS,   HD trapeze bar free standing36      A60-9                                                                                                 D                          D1B R       2006010120060101        A                           
E091200200QFREE STANDING, COMPLETE WITH GRAB BAR                                                                                                                                                                                                                                                                                
E092000100PFRACTURE FRAME, ATTACHED TO BED, INCLUDES WEIGHTS                               Fracture frame attached to b36      A60-9                                                                                                 D                          D1E R       1986010119890101        N                           
E093000100PFRACTURE FRAME, FREE STANDING, INCLUDES WEIGHTS                                 Fracture frame free standing36      A60-9                                                                                                 D                          D1E R       1986010119890101        N                           
E093500100PCONTINUOUS PASSIVE MOTION EXERCISE DEVICE FOR USE ON KNEE ONLY                  Cont pas motion exercise dev31      A60-9                                                                                                 D                          D1E R       1986010120060101        C                           
E094000100PTRAPEZE BAR, FREE STANDING, COMPLETE WITH GRAB BAR                              Trapeze bar free standing   36      A60-9                                                                                                 D                          D1B R       1986010119890101        N                           
E094100100PGRAVITY ASSISTED TRACTION DEVICE, ANY TYPE                                      Gravity assisted traction de36      A60-9                                                                                                 D                          D1E R       1986010119890101        N                           
E094200100PCERVICAL HEAD HARNESS/HALTER                                                    Cervical head harness/halter32      A                                                                                                     C                          D1E APR     1986010119860101        N                           
E094300100PCERVICAL PILLOW                                                                 Cervical pillow             32      A                                                                                                     C                          D1E APR     198601012004010120031231N                           
E094400100PPELVIC BELT/HARNESS/BOOT                                                        Pelvic belt/harness/boot    32      A                                                                                                     C                          D1E APR     1985010119960101        N                           
E094500100PEXTREMITY BELT/HARNESS                                                          Belt/harness extremity      32      A                                                                                                     C                          D1E APR     1985010119960101        N                           
E094600100PFRACTURE, FRAME, DUAL WITH CROSS BARS, ATTACHED TO BED, (E.G. BALKEN, 4 POSTER) Fracture frame dual w cross 36      A60-9                                                                                                 D                          D1E R       1986010119890101        N                           
E094700100PFRACTURE FRAME, ATTACHMENTS FOR COMPLEX PELVIC TRACTION                         Fracture frame attachmnts pe32      A60-9                                                                                                 D                          D1E APR     1986010119890101        N                           
E094800100PFRACTURE FRAME, ATTACHMENTS FOR COMPLEX CERVICAL TRACTION                       Fracture frame attachmnts ce32      A60-9                                                                                                 D                          D1E APR     1986010119890101        N                           
E095000100PWHEELCHAIR ACCESSORY, TRAY, EACH                                                Tray                        00      960-9                                                                                                 D                          D1D APR     1986010120040101        N                           
E095100100PHEEL LOOP/HOLDER, ANY TYPE, WITH OR WITHOUT ANKLE STRAP, EACH                   Loop heel                   00      9                                                                                                     C                          D1D APR     1986010120050101        N                           
E095200100PTOE LOOP/HOLDER, ANY TYPE, EACH                                                 Toe loop/holder, each       00      960-9                                                                                                 D                          D1D APR     1986010120050101        N                           
E095300100PPNEUMATIC TIRE, EACH                                                            Pneumatic tire              00      960-9                                                                        E2211                    I                          D1D APR     198601012006010120051231D                           
E095400100PSEMI-PNEUMATIC CASTER, EACH                                                     Wheelchair semi-pneumatic ca00      960-9                                                                        E2219                    I                          D1D APR     198601012006010120051231D                           
E095500100PWHEELCHAIR ACCESSORY, HEADREST, CUSHIONED, ANY TYPE, INCLUDING FIXED MOUNTING   Cushioned headrest          32      A                                                                                                     C                          D1D APR     2004010120050101        N                           
E095500200QHARDWARE, EACH                                                                                                                                                                                                                                                                                                       
E095600100PWHEELCHAIR ACCESSORY, LATERAL TRUNK OR HIP SUPPORT, ANY TYPE, INCLUDING FIXED   W/c lateral trunk/hip suppor32      A                                                                                                     C                          D1D APR     2004010120050101        N                           
E095600200QMOUNTING HARDWARE, EACH                                                                                                                                                                                                                                                                                              
E095700100PWHEELCHAIR ACCESSORY, MEDIAL THIGH SUPPORT, ANY TYPE, INCLUDING FIXED MOUNTING  W/c medial thigh support    32      A                                                                                                     C                          D1D APR     2004010120050101        N                           
E095700200QHARDWARE, EACH                                                                                                                                                                                                                                                                                                       
E095800100PMANUAL WHEELCHAIR ACCESSORY, ONE-ARM DRIVE ATTACHMENT, EACH                     Whlchr att- conv 1 arm drive00      960-9                                                                                                 D                          D1D R       1986010120040101        N                           
E095900100PMANUAL WHEELCHAIR ACCESSORY, ADAPTER FOR AMPUTEE, EACH                          Amputee adapter             00      960-9                                                                                                 C                          D1D APR     1986010120040101        N                           
E096000100PWHEELCHAIR ACCESSORY, SHOULDER HARNESS/STRAPS OR CHEST STRAP, INCLUDING ANY     W/c shoulder harness/straps 32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E096000200QTYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                               
E096100100PMANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK BRAKE EXTENSION (HANDLE), EACH          Wheelchair brake extension  00      960-9                                                                                                 C                          D1D APR     1986010120040101        N                           
E096200100P1" CUSHION, FOR WHEELCHAIR                                                      Wheelchair 1 inch cushion   00      9                                                                                                     I                          D1D APR     198601012005010120041231N                           
E096300100P2" CUSHION, FOR WHEELCHAIR                                                      Wheelchair 2 inch cushion   00      9                                                                                                     I                          D1D APR     198601012005010120041231N                           
E096400100P3" CUSHION, FOR WHEELCHAIR                                                      Wheelchair 3 inch cushion   00      9                                                                                                     I                          D1D APR     198601012005010120041231N                           
E096500100P4" CUSHION, FOR WHEELCHAIR                                                      Wheelchair 4 inch cushion   00      9                                                                                                     I                          D1D APR     198601012005010120041231N                           
E096600100PMANUAL WHEELCHAIR ACCESSORY, HEADREST EXTENSION, EACH                           Wheelchair head rest extensi00      960-9                                                                                                 C                          D1D APR     1986010120040101        N                           
E096700100PMANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECTIONS, ANY TYPE, REPLACEMENT   Wheelchair hand rims        32      A60-9                                                                                                 D                          D1D APR     1986010120050101        N                           
E096700200QONLY, EACH                                                                                                                                                                                                                                                                                                           
E096800100PCOMMODE SEAT, WHEELCHAIR                                                        Wheelchair commode seat     36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E096900100PNARROWING DEVICE, WHEELCHAIR                                                    Wheelchair narrowing device 32      A60-9                                                                                                 D                          D1D APR     1986010119890101        N                           
E097000100PNO.2 FOOTPLATES, EXCEPT FOR ELEVATING LEG REST                                  Wheelchair no. 2 footplates 00      960-9                                                                        K0037K0042               I                          D1D APR     1986010120010401        N                           
E097100100PMANUAL WHEELCHAIR ACCESSORY, ANTI-TIPPING DEVICE, EACH                          Wheelchair anti-tipping devi00      960-9                                                                        K0021                    C                          D1D APR     1986010120060101        C                           
E097200100PWHEELCHAIR ACCESSORY, TRANSFER BOARD OR DEVICE, EACH                            Transfer board or device    00      9                                                                                                     C                          Z2  APR     198601012006010120051231D                           
E097300100PWHEELCHAIR ACCESSORY, ADJUSTABLE HEIGHT, DETACHABLE ARMREST, COMPLETE ASSEMBLY, W/Ch access det adj armrest 00      960-9                                                                                                 D                          D1D APR     1986010120040101        N                           
E097300200QEACH                                                                                                                                                                                                                                                                                                                 
E097400100PMANUAL WHEELCHAIR ACCESSORY, ANTI-ROLLBACK DEVICE, EACH                         W/Ch access anti-rollback   00      960-9                                                                                                 D                          D1D APR     1986010120040101        N                           
E097500100PREINFORCED SEAT UPHOLSTERY, WHEELCHAIR                                          Wheelchair reinforced seat u00      960-9                                                                                                 I                          D1D APR     198601012004010120031231N                           
E097600100PREINFORCED BACK, WHEELCHAIR, UPHOLSTERY OR OTHER MATERIAL                       Wheelchair reinforced back u00      960-9                                                                                                 I                          D1D APR     198601012004010120031231N                           
E097700100PWEDGE CUSHION, WHEELCHAIR                                                       Wheelchair wedge cushion    32      A                                                                                                     C                          D1D APR     1986010119890101        N                           
E097800100PWHEELCHAIR ACCESSORY,  POSITIONING BELT/SAFETY BELT/PELVIC STRAP, EACH          W/C acc,saf belt pelv strap 00      9                                                                                                     C                          D1D APR     1986010120050101        N                           
E097900100PBELT, SAFETY WITH VELCRO CLOSURE, WHEELCHAIR                                    Wheelchair belt with velcro 00      9                                                                                                     I                          D1D APR     198601012004010120031231N                           
E098000100PSAFETY VEST, WHEELCHAIR                                                         Wheelchair safety vest      32      A                                                                                                     C                          D1D APR     1986010119890101        N                           
E098100100PWHEELCHAIR ACCESSORY, SEAT UPHOLSTERY, REPLACEMENT ONLY, EACH                   Seat upholstery, replacement32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E098200100PWHEELCHAIR ACCESSORY, BACK UPHOLSTERY, REPLACEMENT ONLY, EACH                   Back upholstery, replacement32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E098300100PMANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVERT MANUAL WHEELCHAIR TO       Add pwr joystick            36      A                                                                                                     C                          D1D R       2004010120040101        N                           
E098300200QMOTORIZED WHEELCHAIR, JOYSTICK CONTROL                                                                                                                                                                                                                                                                               
E098400100PMANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVERT MANUAL WHEELCHAIR TO       Add pwr tiller              32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E098400200QMOTORIZED WHEELCHAIR, TILLER CONTROL                                                                                                                                                                                                                                                                                 
E098500100PWHEELCHAIR ACCESSORY, SEAT LIFT MECHANISM                                       W/c seat lift mechanism     32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E098600100PMANUAL WHEELCHAIR ACCESSORY, PUSH ACTIVATED POWER ASSIST, EACH                  Man w/c push-rim pow assist 32      A                                                                                                     C                          D1D APR     2004010120050101        N                           
E099000100PWHEELCHAIR ACCESSORY, ELEVATING LEG REST, COMPLETE ASSEMBLY, EACH               Whellchair elevating leg res00      960-9                                                                                                 C                          D1D APR     1986010120040101        N                           
E099100100PUPHOLSTERY SEAT                                                                 Wheelchair upholstry seat   00      960-9                                                                                                 I                          D1D APR     198601012004010120031231N                           
E099200100PMANUAL WHEELCHAIR ACCESSORY, SOLID SEAT INSERT                                  Wheelchair solid seat insert32      A                                                                                                     C                          D1D APR     1986010120040101        N                           
E099300100PBACK, UPHOLSTERY                                                                Wheelchair back upholstery  00      960-9                                                                                                 I                          D1D APR     198601012004010120031231N                           
E099400100PARM REST, EACH                                                                  Wheelchair arm rest         32      A60-9                                                                                                 D                          D1D APR     1986010119890101        N                           
E099500100PWHEELCHAIR ACCESSORY, CALF REST/PAD, EACH                                       Wheelchair calf rest        00      960-9                                                                                                 C                          D1D APR     1986010120040101        N                           
E099600100PTIRE, SOLID, EACH                                                               Wheelchair tire solid       00      960-9                                                                        E2220                    I                          D1D APR     198601012006010120051231D                           
E099700100PCASTER WITH A FORK                                                              Wheelchair caster w/ a fork 32      A60-9                                                                                                 D                          D1D APR     1986010119890101        N                           
E099800100PCASTER WITHOUT FORK                                                             Wheelchair caster w/o a fork32      A60-9                                                                                                 D                          D1D APR     1986010119890101        N                           
E099900100PPNEUMATIC TIRE WITH WHEEL                                                       Wheelchr pneumatic tire w/wh32      A60-9                                                                                                 D                          D1D APR     1986010119890101        N                           
E100000100PTIRE, PNEUMATIC CASTER                                                          Wheelchair tire pneumatic ca00      960-9                                                                        E2214                    I                          D1D APR     198601012006010120051231D                           
E100100100PWHEEL, SINGLE                                                                   Wheelchair wheel            32      A60-9                                                                        E2224                    D                          D1D APR     198601012006010120051231D                           
E100200100PWHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, TILT ONLY                           Pwr seat tilt               32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E100300100PWHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITHOUT SHEAR         Pwr seat recline            32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E100300200QREDUCTION                                                                                                                                                                                                                                                                                                            
E100400100PWHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITH MECHANICAL SHEAR Pwr seat recline mech       32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E100400200QREDUCTION                                                                                                                                                                                                                                                                                                            
E100500100PWHEELCHAIR ACCESSORY, POWER SEATNG SYSTEM, RECLINE ONLY, WITH POWER SHEAR       Pwr seat recline pwr        32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E100500200QREDUCTION                                                                                                                                                                                                                                                                                                            
E100600100PWHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE,       Pwr seat combo w/o shear    32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E100600200QWITHOUT SHEAR REDUCTION                                                                                                                                                                                                                                                                                              
E100700100PWHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH  Pwr seat combo w/shear      32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E100700200QMECHANICAL SHEAR REDUCTION                                                                                                                                                                                                                                                                                           
E100800100PWHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH  Pwr seat combo pwr shear    32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E100800200QPOWER SHEAR REDUCTION                                                                                                                                                                                                                                                                                                
E100900100PWHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, MECHANICALLY LINKED LEG Add mech leg elevation      32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E100900200QELEVATION SYSTEM, INCLUDING PUSHROD AND LEG REST, EACH                                                                                                                                                                                                                                                               
E101000100PWHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, POWER LEG ELEVATION     Add pwr leg elevation       32      A                                                                                                     C                          D1D APR     2004010120050101        N                           
E101000200QSYSTEM, INCLUDING LEG REST, PAIR                                                                                                                                                                                                                                                                                     
E101100100PMODIFICATION TO PEDIATRIC SIZE WHEELCHAIR, WIDTH ADJUSTMENT PACKAGE (NOT TO BE  Ped wc modify width adjustm 32      A60-9                                                                                                 D                          D1D APR     2003010120050101        N                           
E101100200QDISPENSED WITH INITIAL CHAIR)                                                                                                                                                                                                                                                                                        
E101200100PINTEGRATED SEATING SYSTEM, PLANAR, FOR PEDIATRIC WHEELCHAIR                     Int seat sys planar ped w/c 32      A60-9                                                                                                 D                          D1D APR     200301012005010120041231N                           
E101300100PINTEGRATED SEATING SYSTEM, CONTOURED, FOR PEDIATRIC WHEELCHAIR                  Int seat sys contour ped w/c32      A60-9                                                                                                 D                          D1D APR     200301012005010120041231N                           
E101400100PRECLINING BACK, ADDITION TO PEDIATRIC SIZE WHEELCHAIR                           Reclining back add ped w/c  32      A60-9                                                                                                 D                          D1D APR     2003010120050101        N                           
E101500100PSHOCK ABSORBER FOR MANUAL WHEELCHAIR, EACH                                      Shock absorber for man w/c  32      A                  60.9                                                                               D                          D1D APR     2003010120030101        N                           
E101600100PSHOCK ABSORBER FOR POWER WHEELCHAIR, EACH                                       Shock absorber for power w/c32      A                  60.9                                                                               D                          D1D APR     2003010120030101        N                           
E101700100PHEAVY 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     2003010120030101        N                           
E101700200QEACH                                                                                                                                                                                                                                                                                                                 
E101800100PHEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA HEAVY DUTY POWER WHEELCHAIR,  HD shck absrber for hd powwc32      A                  60.9                                                                               D                          D1D APR     2003010120030101        N                           
E101800200QEACH                                                                                                                                                                                                                                                                                                                 
E101900100PWHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, HEAVY DUTY FEATURE, PATIENT WEIGHT  HD feature power seat       00      9                                                                                                     I                          D1D APR     200401012006010120051231D                           
E101900200QCAPACITY GREATER THAN 250 POUNDS AND LESS THAN OR EQUAL TO 400 POUNDS                                                                                                                                                                                                                                                
E102000100PRESIDUAL LIMB SUPPORT SYSTEM FOR WHEELCHAIR                                     Residual limb support system32      A                  60-6                                                                               D                          D1D APR     2003010120030101        N                           
E102100100PWHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, EXTRA HEAVY DUTY FEATURE, WEIGHT    Ex hd feature power seat    00      9                                                                                                     I                          D1D APR     200401012006010120051231D                           
E102100200QCAPACITY GREATER THAN 400 POUNDS                                                                                                                                                                                                                                                                                     
E102500100PLATERAL THORACIC SUPPORT, NON-CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH         Pedwc lat/thor sup nocontour00      9                                                                                                     I                          D1D APR     200301012006010120051231D                           
E102500200Q(INCLUDES HARDWARE)                                                                                                                                                                                                                                                                                                  
E102600100PLATERAL THORACIC SUPPORT, CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES   Pedwc contoured lat/thor sup00      9                                                                                                     I                          D1D APR     200301012006010120051231D                           
E102600200QHARDWARE)                                                                                                                                                                                                                                                                                                            
E102700100PLATERAL/ANTERIOR SUPPORT, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE)    Ped wc lat/ant support      00      9                                                                                                     I                          D1D APR     200301012006010120051231D                           
E102800100PWHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING       W/c manual swingaway        32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E102800200QHARDWARE FOR JOYSTICK, OTHER CONTROL INTERFACE OR POSITIONING ACCESSORY                                                                                                                                                                                                                                              
E102900100PWHEELCHAIR ACCESSORY, VENTILATOR TRAY, FIXED                                    W/c vent tray fixed         32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E103000100PWHEELCHAIR ACCESSORY, VENTILATOR TRAY, GIMBALED                                 W/c vent tray gimbaled      32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E103100100PROLLABOUT CHAIR, ANY AND ALL TYPES WITH CASTORS 5" OR GREATER                   Rollabout chair with casters36      A60-9                                                                                                 D                          D1D R       1990010119900101        N                           
E103500100PMULTI-POSITIONAL PATIENT TRANSFER SYSTEM, WITH INTEGRATED SEAT, OPERATED BY     Patient transfer system     36      A                  2100                                                                               D                          D1D R       2001010120030101        N                           
E103500200QCARE GIVER                                                                                                                                                                                                                                                                                                           
E103700100PTRANSPORT CHAIR, PEDIATRIC SIZE                                                 Transport chair, ped size   36      A60-9                                                                                                 D                          D1D R       2003010120030101        N                           
E103800100PTRANSPORT CHAIR, ADULT SIZE, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300    Transport chair pt wt<=300lb36      A60-9                                                                                                 D                          D1D R       2003010120060101        C                           
E103800200QPOUNDS                                                                                                                                                                                                                                                                                                               
E103900100PTRANSPORT CHAIR, ADULT SIZE, HEAVY DUTY, PATIENT WEIGHT CAPACITY GREATER THAN   Transport chair pt wt >300lb36      A                                                                                                     C                          D1D R       2005010120060101        C                           
E103900200Q300 POUNDS                                                                                                                                                                                                                                                                                                           
E105000100PFULLY-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE       Whelchr fxd full length arms36      A60-9                                                                                                 D                          D1D R       1986010119840101        N                           
E105000200QELEVATING LEG RESTS                                                                                                                                                                                                                                                                                                  
E106000100PFULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH, SWING AWAY    Wheelchair detachable arms  36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E106000200QDETACHABLE ELEVATING LEGRESTS                                                                                                                                                                                                                                                                                        
E106500100PPOWER ATTACHMENT (TO CONVERT ANY WHEELCHAIR TO MOTORIZED WHEELCHAIR, E.G., SOLO)Wheelchair power attachment 32      A60-9                                                                                                 D                          D1D APR     198601012004010120031231N                           
E106600100PBATTERY CHARGER                                                                 Wheelchair battery charger  00      960-9                                                                                                 I                          D1D APR     198601012004010120031231N                           
E106900100PDEEP CYCLE BATTERY                                                              Wheelchair deep cycle batter00      960-9                                                                                                 I                          D1D APR     198601012004010120031231N                           
E107000100PFULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY    Wheelchair detachable foot r36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E107000200QDETACHABLE FOOTREST                                                                                                                                                                                                                                                                                                  
E108300100PHEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG    Hemi-wheelchair fixed arms  36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E108300200QREST                                                                                                                                                                                                                                                                                                                 
E108400100PHEMI-WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH ARMS, SWING AWAY           Hemi-wheelchair detachable a36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E108400200QDETACHABLE ELEVATING LEG RESTS                                                                                                                                                                                                                                                                                       
E108500100PHEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS       Hemi-wheelchair fixed arms  00      960-9                                                                        K0002                    I                          D1D R       1986010120010401        N                           
E108600100PHEMI-WHEELCHAIR DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE      Hemi-wheelchair detachable a00      960-9                                                                        K0002                    I                          D1D R       1986010120010401        N                           
E108600200QFOOTRESTS                                                                                                                                                                                                                                                                                                            
E108700100PHIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY        Wheelchair lightwt fixed arm36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E108700200QDETACHABLE ELEVATING LEG RESTS                                                                                                                                                                                                                                                                                       
E108800100PHIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH,      Wheelchair lightweight det a36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E108800200QSWING AWAY DETACHABLE ELEVATING LEG RESTS                                                                                                                                                                                                                                                                            
E108900100PHIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED LENGTH ARMS, SWING AWAY DETACHABLE  Wheelchair lightwt fixed arm00      960-9                                                                        K0004                    I                          D1D R       1986010120010401        N                           
E108900200QFOOTREST                                                                                                                                                                                                                                                                                                             
E109000100PHIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH,      Wheelchair lightweight det a00      960-9                                                                        K0004                    I                          D1D R       1986010120010401        N                           
E109000200QSWING AWAY DETACHABLE FOOT RESTS                                                                                                                                                                                                                                                                                     
E109100100PYOUTH WHEELCHAIR, ANY TYPE                                                      Wheelchair youth            36      A60-9                                                                                                 D                          D1D R       198601012003010120021231N                           
E109200100PWIDE HEAVY DUTY WHEEL CHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH), SWING AWAY  Wheelchair wide w/ leg rests36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E109200200QDETACHABLE ELEVATING LEG RESTS                                                                                                                                                                                                                                                                                       
E109300100PWIDE HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH ARMS, SWING     Wheelchair wide w/ foot rest36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E109300200QAWAY DETACHABLE FOOTRESTS                                                                                                                                                                                                                                                                                            
E110000100PSEMI-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE        Whchr s-recl fxd arm leg res36      A60-9                                                                                                 D                          D1D R       1986010119880101        N                           
E110000200QELEVATING LEG RESTS                                                                                                                                                                                                                                                                                                  
E111000100PSEMI-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) ELEVATING LEG  Wheelchair semi-recl detach 36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E111000200QREST                                                                                                                                                                                                                                                                                                                 
E113000100PSTANDARD WHEELCHAIR, FIXED FULL LENGTH ARMS, FIXED OR SWING AWAY DETACHABLE     Whlchr stand fxd arm ft rest00      960-9                                                                        K0001                    I                          D1D R       1986010120010401        N                           
E113000200QFOOTRESTS                                                                                                                                                                                                                                                                                                            
E114000100PWHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH, SWING AWAY DETACHABLE         Wheelchair standard detach a00      960-9                                                                        K0001                    I                          D1D R       1986010120010401        N                           
E114000200QFOOTRESTS                                                                                                                                                                                                                                                                                                            
E115000100PWHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH SWING AWAY DETACHABLE          Wheelchair standard w/ leg r36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E115000200QELEVATING LEGRESTS                                                                                                                                                                                                                                                                                                   
E116000100PWHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEGRESTS    Wheelchair fixed arms       36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E116100100PMANUAL ADULT SIZE WHEELCHAIR, INCLUDES TILT IN SPACE                            Manual adult wc w tiltinspac36      A                                                                                                     C                          D1D APR     2003010120030101        N                           
E117000100PAMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING     Whlchr ampu fxd arm leg rest36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E117000200QLEGRESTS                                                                                                                                                                                                                                                                                                             
E117100100PAMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, WITHOUT FOOTRESTS OR LEGREST        Wheelchair amputee w/o leg r36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E117200100PAMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) WITHOUT FOOTRESTS OR  Wheelchair amputee detach ar36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E117200200QLEGREST                                                                                                                                                                                                                                                                                                              
E118000100PAMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY DETACHABLE Wheelchair amputee w/ foot r36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E118000200QFOOTRESTS                                                                                                                                                                                                                                                                                                            
E119000100PAMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY DETACHABLE Wheelchair amputee w/ leg re36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E119000200QELEVATING LEGRESTS                                                                                                                                                                                                                                                                                                   
E119500100PHEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING  Wheelchair amputee heavy dut36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E119500200QLEGRESTS                                                                                                                                                                                                                                                                                                             
E120000100PAMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST      Wheelchair amputee fixed arm36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E121000100PMOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING   Whlchr moto ful arm leg rest36      A60-5  60-9                                                                                           D                          D1D APR     198601012006010120051231D                           
E121000200QLEG RESTS                                                                                                                                                                                                                                                                                                            
E121100100PMOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH SWING AWAY,           Wheelchair motorized w/ det 36      A60-5  60-9                                                                                           D                          D1D APR     198801012006010120051231D                           
E121100200QDETACHABLE ELEVATING LEG REST                                                                                                                                                                                                                                                                                        
E121200100PMOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS  Wheelchair motorized w full 00      960-5  60-9                                                                  K0010                    I                          D1D APR     198801012006010120051231D                           
E121300100PMOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY           Wheelchair motorized w/ det 00      960-5  60-9                                                                  K0010                    I                          D1D APR     198801012006010120051231D                           
E121300200QDETACHABLE FOOT RESTS                                                                                                                                                                                                                                                                                                
E122000100PWHEELCHAIR; SPECIALLY SIZED OR CONSTRUCTED, (INDICATE BRAND NAME, MODEL NUMBER, Whlchr special size/constrc 45      A60-6                                                                                                 D                          D1D P       1986010119900101        N                           
E122000200QIF ANY) AND JUSTIFICATION                                                                                                                                                                                                                                                                                            
E122100100PWHEELCHAIR WITH FIXED ARM, FOOTRESTS                                            Wheelchair spec size w foot 36      A60-6                                                                                                 D                          D1D R       1986010119900101        N                           
E122200100PWHEELCHAIR WITH FIXED ARM, ELEVATING LEGRESTS                                   Wheelchair spec size w/ leg 36      A60-6                                                                                                 D                          D1D R       1986010119900101        N                           
E122300100PWHEELCHAIR WITH DETACHABLE ARMS, FOOTRESTS                                      Wheelchair spec size w foot 36      A60-6                                                                                                 D                          D1D R       1986010119900101        N                           
E122400100PWHEELCHAIR WITH DETACHABLE ARMS, ELEVATING LEGRESTS                             Wheelchair spec size w/ leg 36      A60-6                                                                                                 D                          D1D R       1986010119900101        N                           
E122500100PWHEELCHAIR ACCESSORY, MANUAL SEMI-RECLINING BACK, (RECLINE GREATER THAN 15      Manual semi-reclining back  36      A60-6                                                                                                 D                          D1D R       1986010120050101        N                           
E122500200QDEGREES, BUT LESS THAN 80 DEGREES), EACH                                                                                                                                                                                                                                                                             
E122600100PWHEELCHAIR ACCESSORY, MANUAL FULLY RECLINING BACK, (RECLINE GREATER THAN 80     Manual fully reclining back 00      960-9                                                                                                 D                          D1D APR     1986010120050101        N                           
E122600200QDEGREES), EACH                                                                                                                                                                                                                                                                                                       
E122700100PSPECIAL HEIGHT ARMS FOR WHEELCHAIR                                              Wheelchair spec sz spec ht a32      A60-6                                                                                                 D                          D1D APR     1986010119900101        N                           
E122800100PSPECIAL BACK HEIGHT FOR WHEELCHAIR                                              Wheelchair spec sz spec ht b36      A60-6                                                                                                 D                          D1D R       1986010119900101        N                           
E122900100PWHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIED                             Pediatric wheelchair NOS    32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E123000100PPOWER OPERATED VEHICLE (THREE OR FOUR WHEEL NONHIGHWAY) SPECIFY BRAND NAME AND  Power operated vehicle      32      A60-5              4107.6                                                                             D                          D1D APR     1986010119910101        N                           
E123000200QMODEL NUMBER                                                                                                                                                                                                                                                                                                         
E123100100PWHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITH SEATING      Rigid ped w/c tilt-in-space 36      A60-9                                                                                                 D                          D1D APR     2003010120030101        N                           
E123100200QSYSTEM                                                                                                                                                                                                                                                                                                               
E123200100PWHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITH SEATING    Folding ped wc tilt-in-space36      A60-9                                                                                                 D                          D1D APR     2003010120030101        N                           
E123200200QSYSTEM                                                                                                                                                                                                                                                                                                               
E123300100PWHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITHOUT SEATING   Rig ped wc tltnspc w/o seat 36      A60-9                                                                                                 D                          D1D APR     2003010120030101        N                           
E123300200QSYSTEM                                                                                                                                                                                                                                                                                                               
E123400100PWHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITHOUT SEATING Fld ped wc tltnspc w/o seat 36      A60-9                                                                                                 D                          D1D APR     2003010120030101        N                           
E123400200QSYSTEM                                                                                                                                                                                                                                                                                                               
E123500100PWHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITH SEATING SYSTEM              Rigid ped wc adjustable     36      A60-9                                                                                                 D                          D1D APR     2003010120030101        N                           
E123600100PWHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITH SEATING SYSTEM            Folding ped wc adjustable   36      A60-9                                                                                                 D                          D1D APR     2003010120030101        N                           
E123700100PWHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITHOUT SEATING SYSTEM           Rgd ped wc adjstabl w/o seat36      A60-9                                                                                                 D                          D1D APR     2003010120030101        N                           
E123800100PWHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITHOUT SEATING SYSTEM         Fld ped wc adjstabl w/o seat36      A60-9                                                                                                 D                          D1D APR     2003010120030101        N                           
E123900100PPOWER WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIED                       Ped power wheelchair NOS    36      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E124000100PLIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS, (DESK OR FULL LENGTH) SWING AWAY       Whchr litwt det arm leg rest36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E124000200QDETACHABLE, ELEVATING LEGREST                                                                                                                                                                                                                                                                                        
E125000100PLIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST  Wheelchair lightwt fixed arm00      960-9                                                                        K0003                    I                          D1D R       1986010120010401        N                           
E126000100PLIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY        Wheelchair lightwt foot rest00      960-9                                                                        K0003                    I                          D1D R       1986010120010401        N                           
E126000200QDETACHABLE FOOTREST                                                                                                                                                                                                                                                                                                  
E127000100PLIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING Wheelchair lightweight leg r36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E127000200QLEGRESTS                                                                                                                                                                                                                                                                                                             
E128000100PHEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) ELEVATING LEGRESTS Whchr h-duty det arm leg res36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E128500100PHEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST   Wheelchair heavy duty fixed 00      960-9                                                                        K0006                    I                          D1D R       1986010120010401        N                           
E129000100PHEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY         Wheelchair hvy duty detach a00      960-9                                                                        K0006                    I                          D1D R       1986010120010401        N                           
E129000200QDETACHABLE FOOTREST                                                                                                                                                                                                                                                                                                  
E129500100PHEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, ELEVATING LEGREST                Wheelchair heavy duty fixed 36      A60-9                                                                                                 D                          D1D R       1986010119890101        N                           
E129600100PSPECIAL WHEELCHAIR SEAT HEIGHT FROM FLOOR                                       Wheelchair special seat heig32      A60-6                                                                                                 D                          D1D APR     1986010119890101        N                           
E129700100PSPECIAL WHEELCHAIR SEAT DEPTH, BY UPHOLSTERY                                    Wheelchair special seat dept32      A60-6                                                                                                 D                          D1D APR     1986010119890101        N                           
E129800100PSPECIAL WHEELCHAIR SEAT DEPTH AND/OR WIDTH, BY CONSTRUCTION                     Wheelchair spec seat depth/w32      A60-6                                                                                                 D                          D1D APR     1986010119890101        N                           
E130000100PWHIRLPOOL, PORTABLE (OVERTUB TYPE)                                              Whirlpool portable          00      960-9                                                                                                 M                          D1E APR     1986010119960101        N                           
E131000100PWHIRLPOOL, NON-PORTABLE (BUILT-IN TYPE)                                         Whirlpool non-portable      32      A60-9                                                                                                 D                          D1E APR     1986010119960101        N                           
E134000100PREPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT REQUIRING THE SKILL  Repair for DME, per 15 min  46      A                  2100.4                                                                             D                          D1E 9       1997010119970101        N                           
E134000200QOF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES                                                                                                                                                                                                                                                                     
E135300100PREGULATOR                                                                       Oxygen supplies regulator   33      A60-4              4107.9                                                                             D                          D1C R       1986010119890101        N                           
E135500100PSTAND/RACK                                                                      Oxygen supplies stand/rack  33      A60-4                                                                                                 D                          D1C R       1986010119890101        N                           
E137200100PIMMERSION EXTERNAL HEATER FOR NEBULIZER                                         Oxy suppl heater for nebuliz32      A60-4                                                                                                 D                          D1E APR     1986010119960101        N                           
E139000100POXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR  Oxygen concentrator         33      A60-4                                                                                                 D                          D1C R       2000010120040101        N                           
E139000200QGREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE                                                                                                                                                                                                                                                             
E139100100POXYGEN CONCENTRATOR, DUAL DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR    Oxygen concentrator, dual   33      A60-4                                                                                                 D                          D1C R       2004010120040101        N                           
E139100200QGREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE, EACH                                                                                                                                                                                                                                                       
E139200100PPORTABLE OXYGEN CONCENTRATOR, RENTAL                                            Portable oxygen concentrator33      A60-4                                                                                                 D                          D1C R       2006010120060101        A                           
E139900100PDURABLE MEDICAL EQUIPMENT, MISCELLANEOUS                                        Durable medical equipment mi46      A                                                                                                     C                          D1E APR     1986010119960101        N                           
E140500100POXYGEN AND WATER VAPOR ENRICHING SYSTEM WITH HEATED DELIVERY                    O2/water vapor enrich w/heat33      A60-4              4107                                                                               D                          D1C R       1988010119900101        N                           
E140600100POXYGEN AND WATER VAPOR ENRICHING SYSTEM WITHOUT HEATED DELIVERY                 O2/water vapor enrich w/o he33      A60-4              4107                                                                               D                          D1C R       1988010119900101        N                           
E150000100PCENTRIFUGE, FOR DIALYSIS                                                        Centrifuge                  52      A                                                                                                     D                      0017P9B L       2002010120020101        N                           
E151000100PKIDNEY, DIALYSATE DELIVERY SYST. KIDNEY MACHINE, PUMP RECIRCULAT- ING, AIR      Kidney dialysate delivry sys52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E151000200QREMOVAL SYST, FLOWRATE METER, POWER OFF, HEATER AND TEMPERATURE CONTROL WITH                                                                                                                                                                                                                                         
E151000300QALARM, I.V.POLES, PRESSURE GAUGE, CONCENTRATE CONTAINER                                                                                                                                                                                                                                                              
E152000100PHEPARIN INFUSION PUMP FOR HEMODIALYSIS                                          Heparin infusion pump       52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E153000100PAIR BUBBLE DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT                         Replacement air bubble detec52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E154000100PPRESSURE ALARM FOR HEMODIALYSIS, EACH, REPLACEMENT                              Replacement pressure alarm  52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E155000100PBATH CONDUCTIVITY METER FOR HEMODIALYSIS, EACH                                  Bath conductivity meter     52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E156000100PBLOOD LEAK DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT                         Replace blood leak detector 52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E157000100PADJUSTABLE CHAIR, FOR ESRD PATIENTS                                             Adjustable chair for esrd pt52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E157500100PTRANSDUCER PROTECTORS/FLUID BARRIERS, FOR HEMODIALYSIS, ANY SIZE, PER 10        Transducer protect/fld bar  52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E158000100PUNIPUNCTURE CONTROL SYSTEM FOR HEMODIALYSIS                                     Unipuncture control system  52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E159000100PHEMODIALYSIS MACHINE                                                            Hemodialysis machine        52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E159200100PAUTOMATIC INTERMITTENT PERITIONEAL DIALYSIS SYSTEM                              Auto interm peritoneal dialy52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E159400100PCYCLER DIALYSIS MACHINE FOR PERITONEAL DIALYSIS                                 Cycler dialysis machine     52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E160000100PDELIVERY AND/OR INSTALLATION CHARGES FOR HEMODIALYSIS EQUIPMENT                 Deli/install chrg hemo equip52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E161000100PREVERSE OSMOSIS WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS                     Reverse osmosis h2o puri sys52      A55-1A                                                                                                D                      0017P9B L       1986010120020101        N                           
E161500100PDEIONIZER WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS                           Deionizer H2O puri system   52      A55-1A                                                                                                D                      0017P9B L       1986010120020101        N                           
E162000100PBLOOD PUMP FOR HEMODIALYSIS, REPLACEMENT                                        Replacement blood pump      52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E162500100PWATER SOFTENING SYSTEM, FOR HEMODIALYSIS                                        Water softening system      52      A55-1B                                                                                                D                      0017P9B L       1986010120020101        N                           
E163000100PRECIPROCATING PERITONEAL DIALYSIS SYSTEM                                        Reciprocating peritoneal dia52      A                                                                                                     C                      0017P9B L       1986010120020101        N                           
E163200100PWEARABLE ARTIFICIAL KIDNEY, EACH                                                Wearable artificial kidney  52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E163400100PPERITONEAL DIALYSIS CLAMPS, EACH                                                Peritoneal dialysis clamp   52      A                  4270                                                                               D                          P9B L       2004010120040101        N                           
E163500100PCOMPACT (PORTABLE) TRAVEL HEMODIALYZER SYSTEM                                   Compact travel hemodialyzer 52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E163600100PSORBENT CARTRIDGES, FOR HEMODIALYSIS, PER 10                                    Sorbent cartridges per 10   52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E163700100PHEMOSTATS, EACH                                                                 Hemostats for dialysis, each52      A                                                                                                     D                      0017P9B L       2002010120030101        N                           
E163800100PHEATING PAD, FOR PERITONEAL DIALYSIS, ANY SIZE, EACH                            Peri dialysis heating pad   52      A                                                                            E0210                    D                      0017P9B L       200201012003010120021231N                           
E163900100PSCALE, EACH                                                                     Dialysis scale              52      A                                                                                                     D                      0017P9B L       2002010120030101        N                           
E169900100PDIALYSIS EQUIPMENT, NOT OTHERWISE SPECIFIED                                     Dialysis equipment noc      52      A                                                                                                     D                      0017P9B L       1986010120020101        N                           
E170000100PJAW MOTION REHABILITATION SYSTEM                                                Jaw motion rehab system     32      A                                                                                                     C                          D1E APR     1993010119971020        N                           
E170100100PREPLACEMENT CUSHIONS FOR JAW MOTION REHABILITATION SYSTEM, PKG. OF 6            Repl cushions for jaw motion34      A                                                                                                     C                          D1E P       1993010119960101        N                           
E170200100PREPLACEMENT MEASURING SCALES FOR JAW MOTION REHABILITATION SYSTEM, PKG. OF 200  Repl measr scales jaw motion34      A                                                                                                     C                          D1E P       1993010119960101        N                           
E180000100PDYNAMIC ADJUSTABLE ELBOW EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE      Adjust elbow ext/flex device36      A                                                                                                     C                          D1E PR      1996010120020101        N                           
E180000200QMATERIAL                                                                                                                                                                                                                                                                                                             
E180100100PBI-DIRECTIONAL STATIC PROGRESSIVE STRETCH ELBOW DEVICE WITH RANGE OF MOTION     SPS elbow device            36      A                                                                                                     C                          D1E PR      2002010120020101        N                           
E180100200QADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                                           
E180200100PDYNAMIC ADJUSTABLE FOREARM PRONATION/SUPINATION DEVICE, INCLUDES SOFT INTERFACE Adjst forearm pro/sup device36      A                                                                                                     C                          D1E R       2003010120030101        N                           
E180200200QMATERIAL                                                                                                                                                                                                                                                                                                             
E180500100PDYNAMIC ADJUSTABLE WRIST EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE    Adjust wrist ext/flex device36      A                                                                                                     C                          D1E PR      1996010120020101        N                           
E180500200QMATERIAL                                                                                                                                                                                                                                                                                                             
E180600100PBI-DIRECTIONAL STATIC PROGRESSIVE STRETCH WRIST DEVICE WITH RANGE OF MOTION     SPS wrist device            36      A                                                                                                     C                          D1E PR      2002010120020101        N                           
E180600200QADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                                           
E181000100PDYNAMIC ADJUSTABLE KNEE EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE     Adjust knee ext/flex device 36      A                                                                                                     C                          D1E PR      1996010120020101        N                           
E181000200QMATERIAL                                                                                                                                                                                                                                                                                                             
E181100100PBI-DIRECTIONAL STATIC PROGRESSIVE STRETCH KNEE DEVICE WITH RANGE OF MOTION      SPS knee device             36      A                                                                                                     C                          D1E PR      2002010120020101        N                           
E181100200QADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                                           
E181200100PDYNAMIC KNEE, EXTENSION/FLEXION DEVICE WITH ACTIVE RESISTANCE CONTROL           Knee ext/flex w act res ctrl36      A                                                                                                     C                          D1E PR      2006010120060101        A                           
E181500100PDYNAMIC ADJUSTABLE ANKLE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE      Adjust ankle ext/flex device36      A                                                                                                     C                          D1E PR      1996010120020101        N                           
E181500200QMATERIAL                                                                                                                                                                                                                                                                                                             
E181600100PBI-DIRECTIONAL STATIC PROGRESSIVE STRETCH ANKLE DEVICE WITH RANGE OF MOTION     SPS ankle device            36      A                                                                                                     C                          D1E PR      2002010120020101        N                           
E181600200QADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                                           
E181800100PBI-DIRECTIONAL STATIC PROGRESSIVE STRETCH FOREARM PRONATION / SUPINATION DEVICE SPS forearm device          36      A                                                                                                     C                          D1E PR      2002010120020101        N                           
E181800200QWITH RANGE OF MOTION ADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                      
E182000100PREPLACEMENT SOFT INTERFACE MATERIAL, DYNAMIC ADJUSTABLE EXTENSION/FLEXION DEVICESoft interface material     32      A                                                                                                     C                          D1E PR      1996010120020101        N                           
E182100100PREPLACEMENT SOFT INTERFACE MATERIAL/CUFFS FOR BI-DIRECTIONAL STATIC PROGRESSIVE Replacement interface SPSD  32      A                                                                                                     C                          D1E PR      2002010120020101        N                           
E182100200QSTRETCH DEVICE                                                                                                                                                                                                                                                                                                       
E182500100PDYNAMIC ADJUSTABLE FINGER EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE     Adjust finger ext/flex devc 36      A                                                                                                     C                          D1E PR      1996010120020101        N                           
E182500200QMATERIAL                                                                                                                                                                                                                                                                                                             
E183000100PDYNAMIC ADJUSTABLE TOE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE        Adjust toe ext/flex device  36      A                                                                                                     C                          D1E PR      1996010120020101        N                           
E183000200QMATERIAL                                                                                                                                                                                                                                                                                                             
E184000100PDYNAMIC ADJUSTABLE SHOULDER FLEXION / ABDUCTION / ROTATION DEVICE, INCLUDES     Adj shoulder ext/flex device36      A                                                                                                     C                          D1E PR      2002010120020101        N                           
E184000200QSOFT INTERFACE MATERIAL                                                                                                                                                                                                                                                                                              
E184100100PMULTI-DIRECTIONAL STATIC PROGRESSIVE STRETCH SHOULDER DEVICE, WITH RANGE OF     Static str shldr dev rom adj36      A                                                                                                     C                          D1E R       2005010120050101        N                           
E184100200QMOTION ADJUSTABILITY, INCLUDES CUFFS                                                                                                                                                                                                                                                                                 
E190200100PCOMMUNICATION BOARD, NON-ELECTRONIC AUGMENTATIVE OR ALTERNATIVE COMMUNICATION   AAC non-electronic board    00      9                                                                                                     C                          Z2  APR     2002010120020101        N                           
E190200200QDEVICE                                                                                                                                                                                                                                                                                                               
E200000100PGASTRIC SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC              Gastric suction pump hme mdl36      A                                                                                                     C                          D1E R       2002010120020101        N                           
E210000100PBLOOD GLUCOSE MONITOR WITH INTEGRATED VOICE SYNTHESIZER                         Bld glucose monitor w voice 32      A60-11                                                                                                D                          D1E APR     2002010120020101        N                           
E210100100PBLOOD GLUCOSE MONITOR WITH INTEGRATED LANCING/BLOOD SAMPLE                      Bld glucose monitor w lance 32      A60-11                                                                                                D                          D1E APR     2002010120020101        N                           
E212000100PPULSE GENERATOR SYSTEM FOR TYMPANIC TREATMENT OF INNER EAR ENDOLYMPHATIC FLUID  Pulse gen sys tx endolymp fl36      A                                                                                                     C                          D1E R       2004010120040101        N                           
E220100100PMANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME, WIDTH GREATER THAN OR      Man w/ch acc seat w>=20<2432      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E220100200QEQUAL TO 20 INCHES AND LESS THAN 24 INCHES                                                                                                                                                                                                                                                                           
E220200100PMANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 24-27 INCHES         Seat width 24-27 in         32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E220300100PMANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 20 TO LESS THAN 22   Frame depth less than 22 in 32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E220300200QINCHES                                                                                                                                                                                                                                                                                                               
E220400100PMANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 22 TO 25 INCHES      Frame depth 22 to 25 in     32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E220500100PMANUAL WHEELCHAIR ACCESSORY, HANDRIM WITHOUT PROJECTIONS, ANY TYPE, REPLACEMENT Manual wc accessory, handrim32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E220500200QONLY, EACH                                                                                                                                                                                                                                                                                                           
E220600100PMANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK ASSEMBLY, COMPLETE, EACH                Complete wheel lock assembly32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E220700100PWHEELCHAIR ACCESSORY, CRUTCH AND CANE HOLDER, EACH                              Crutch and cane holder      32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E220800100PWHEELCHAIR ACCESSORY, CYLINDER TANK CARRIER, EACH                               Cylinder tank carrier       32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E220900100PWHEELCHAIR ACCESSORY, ARM TROUGH, EACH                                          Arm trough each             32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221000100PWHEELCHAIR ACCESSORY, BEARINGS, ANY TYPE, REPLACEMENT ONLY, EACH                Wheelchair bearings         32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221100100PMANUAL WHEELCHAIR ACCESSORY, PNEUMATIC PROPULSION TIRE, ANY SIZE, EACH          Pneumatic propulsion tire   32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221200100PMANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC PROPULSION TIRE, ANY SIZE, EACH Pneumatic prop tire tube    32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221300100PMANUAL WHEELCHAIR ACCESSORY, INSERT FOR PNEUMATIC PROPULSION TIRE (REMOVABLE),  Pneumatic prop tire insert  32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221300200QANY TYPE, ANY SIZE, EACH                                                                                                                                                                                                                                                                                             
E221400100PMANUAL WHEELCHAIR ACCESSORY, PNEUMATIC CASTER TIRE, ANY SIZE, EACH              Pneumatic caster tire each  32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221500100PMANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC CASTER TIRE, ANY SIZE, EACH     Pneumatic caster tire tube  32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221600100PMANUAL WHEELCHAIR ACCESSORY, FOAM FILLED PROPULSION TIRE, ANY SIZE, EACH        Foam filled propulsion tire 32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221700100PMANUAL WHEELCHAIR ACCESSORY, FOAM FILLED CASTER TIRE, ANY SIZE, EACH            Foam filled caster tire each32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221800100PMANUAL WHEELCHAIR ACCESSORY, FOAM PROPULSION TIRE, ANY SIZE, EACH               Foam propulsion tire each   32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E221900100PMANUAL WHEELCHAIR ACCESSORY, FOAM CASTER TIRE, ANY SIZE, EACH                   Foam caster tire any size ea32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E222000100PMANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) PROPULSION TIRE, ANY SIZE,  Solid propulsion tire each  32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E222000200QEACH                                                                                                                                                                                                                                                                                                                 
E222100100PMANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE),    Solid caster tire each      32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E222100200QANY SIZE, EACH                                                                                                                                                                                                                                                                                                       
E222200100PMANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED Solid caster integrated whl 32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E222200200QWHEEL, ANY SIZE, EACH                                                                                                                                                                                                                                                                                                
E222300100PMANUAL WHEELCHAIR ACCESSORY, VALVE, ANY TYPE, REPLACEMENT ONLY, EACH            Valve replacement only each 32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E222400100PMANUAL WHEELCHAIR ACCESSORY, PROPULSION WHEEL EXCLUDES TIRE, ANY SIZE, EACH     Propulsion whl excludes tire32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E222500100PMANUAL WHEELCHAIR ACCESSORY, CASTER WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT  Caster wheel excludes tire  32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E222500200QONLY, EACH                                                                                                                                                                                                                                                                                                           
E222600100PMANUAL WHEELCHAIR ACCESSORY, CASTER FORK, ANY SIZE, REPLACEMENT ONLY, EACH      Caster fork replacement only32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E229100100PBACK, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE  Planar back for ped size wc 00      9                                                                                                     I                          D1E APR     2005010120050101        N                           
E229200100PSEAT, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE  Planar seat for ped size wc 00      9                                                                                                     I                          D1E APR     2005010120050101        N                           
E229300100PBACK, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING        Contour back for ped size wc00      9                                                                                                     I                          D1E APR     2005010120050101        N                           
E229300200QHARDWARE                                                                                                                                                                                                                                                                                                             
E229400100PSEAT, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING        Contour seat for ped size wc00      9                                                                                                     I                          D1E APR     2005010120050101        N                           
E229400200QHARDWARE                                                                                                                                                                                                                                                                                                             
E230000100PPOWER WHEELCHAIR ACCESSORY, POWER SEAT ELEVATION SYSTEM                         Pwr seat elevation sys      32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E230100100PPOWER WHEELCHAIR ACCESSORY, POWER STANDING SYSTEM                               Pwr standing                32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E231000100PPOWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER Electro connect btw control 32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E231000200QAND ONE POWER SEATING SYSTEM MOTOR, INCLUDING ALL RELATED ELECTRONICS,                                                                                                                                                                                                                                               
E231000300QINDICATOR FEATURE, MECHANICAL FUNCTION SELECTION SWITCH, AND FIXED MOUNTING                                                                                                                                                                                                                                          
E231000400QHARDWARE                                                                                                                                                                                                                                                                                                             
E231100100PPOWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER Electro connect btw 2 sys   32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E231100200QAND TWO OR MORE POWER SEATING SYSTEM MOTORS, INCLUDING ALL RELATED ELECTRONICS,                                                                                                                                                                                                                                      
E231100300QINDICATOR FEATURE, MECHANICAL FUNCTION SELECTION SWITCH, AND FIXED MOUNTING                                                                                                                                                                                                                                          
E231100400QHARDWARE                                                                                                                                                                                                                                                                                                             
E232000100PPOWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, REMOTE JOYSTICK OR  Hand chin control           32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232000200QTOUCHPAD, PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, AND FIXED MOUNTING                                                                                                                                                                                                                                        
E232000300QHARDWARE                                                                                                                                                                                                                                                                                                             
E232100100PPOWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE, REMOTE JOYSTICK,            Hand interface joystick     32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232100200QNONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH, AND                                                                                                                                                                                                                                      
E232100300QFIXED MOUNTING HARDWARE                                                                                                                                                                                                                                                                                              
E232200100PPOWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE, MULTIPLE MECHANICAL         Mult mech switches          32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232200200QSWITCHES, NONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP                                                                                                                                                                                                                                        
E232200300QSWITCH, AND FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                                                                  
E232300100PPOWER WHEELCHAIR ACCESSORY, SPECIALTY JOYSTICK HANDLE FOR HAND CONTROL          Special joystick handle     32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232300200QINTERFACE, PREFABRICATED                                                                                                                                                                                                                                                                                             
E232400100PPOWER WHEELCHAIR ACCESSORY, CHIN CUP FOR CHIN CONTROL INTERFACE                 Chin cup interface          32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232500100PPOWER WHEELCHAIR ACCESSORY, SIP AND PUFF INTERFACE, NONPROPORTIONAL, INCLUDING  Sip and puff interface      32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232500200QALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH, AND MANUAL SWINGAWAY MOUNTING                                                                                                                                                                                                                                       
E232500300QHARDWARE                                                                                                                                                                                                                                                                                                             
E232600100PPOWER WHEELCHAIR ACCESSORY, BREATH TUBE KIT FOR SIP AND PUFF INTERFACE          Breath tube kit             32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232700100PPOWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, MECHANICAL, PROPORTIONAL,   Head control interface mech 32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232700200QINCLUDING ALL RELATED ELECTRONICS, MECHANICAL DIRECTION CHANGE SWITCH, AND                                                                                                                                                                                                                                           
E232700300QFIXED MOUNTING HARDWARE                                                                                                                                                                                                                                                                                              
E232800100PPOWER WHEELCHAIR ACCESSORY, HEAD CONTROL OR EXTREMITY CONTROL INTERFACE,        Head/extremity control inter32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232800200QELECTRONIC, PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS AND FIXED MOUNTING                                                                                                                                                                                                                                       
E232800300QHARDWARE                                                                                                                                                                                                                                                                                                             
E232900100PPOWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, CONTACT SWITCH MECHANISM,   Head control nonproportional32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E232900200QNONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH,                                                                                                                                                                                                                                          
E232900300QMECHANICAL DIRECTION CHANGE SWITCH, HEAD ARRAY, AND FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                          
E233000100PPOWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, PROXIMITY SWITCH MECHANISM, Head control proximity switc32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E233000200QNONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH,                                                                                                                                                                                                                                          
E233000300QMECHANICAL DIRECTION CHANGE SWITCH, HEAD ARRAY, AND FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                          
E233100100PPOWER WHEELCHAIR ACCESSORY, ATTENDANT CONTROL, PROPORTIONAL, INCLUDING ALL      Attendant control           32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E233100200QRELATED ELECTRONICS AND FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                                                      
E234000100PPOWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 20-23 INCHES          W/c wdth 20-23 in seat frame32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E234100100PPOWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 24-27 INCHES          W/c wdth 24-27 in seat frame32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E234200100PPOWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 20 OR 21 INCHES       W/c dpth 20-21 in seat frame32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E234300100PPOWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 22-25 INCHES          W/c dpth 22-25 in seat frame32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E235100100PPOWER WHEELCHAIR ACCESSORY, ELECTRONIC INTERFACE TO OPERATE SPEECH GENERATING   Electronic SGD interface    32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E235100200QDEVICE USING POWER WHEELCHAIR CONTROL INTERFACE                                                                                                                                                                                                                                                                      
E236000100PPOWER WHEELCHAIR ACCESSORY, 22 NF NON-SEALED LEAD ACID BATTERY, EACH            22nf nonsealed leadacid     32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E236100100PPOWER WHEELCHAIR ACCESSORY, 22NF SEALED LEAD ACID BATTERY, EACH, (E.G. GEL      22nf sealed leadacid battery32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E236100200QCELL, ABSORBED GLASSMAT)                                                                                                                                                                                                                                                                                             
E236200100PPOWER WHEELCHAIR ACCESSORY, GROUP 24 NON-SEALED LEAD ACID BATTERY, EACH         Gr24 nonsealed leadacid     32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E236300100PPOWER WHEELCHAIR ACCESSORY, GROUP 24 SEALED LEAD ACID BATTERY, EACH (E.G. GEL   Gr24 sealed leadacid battery32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E236300200QCELL, ABSORBED GLASSMAT)                                                                                                                                                                                                                                                                                             
E236400100PPOWER WHEELCHAIR ACCESSORY, U-1 NON-SEALED LEAD ACID BATTERY, EACH              U1nonsealed leadacid battery32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E236500100PPOWER WHEELCHAIR ACCESSORY, U-1 SEALED LEAD ACID BATTERY, EACH (E.G. GEL CELL,  U1 sealed leadacid battery  32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E236500200QABSORBED GLASSMAT)                                                                                                                                                                                                                                                                                                   
E236600100PPOWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, SINGLE MODE, FOR USE WITH ONLY ONE Battery charger, single mode32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E236600200QBATTERY TYPE, SEALED OR NON-SEALED, EACH                                                                                                                                                                                                                                                                             
E236700100PPOWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, DUAL MODE, FOR USE WITH EITHER     Battery charger, dual mode  32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E236700200QBATTERY TYPE, SEALED OR NON-SEALED, EACH                                                                                                                                                                                                                                                                             
E236800100PPOWER WHEELCHAIR COMPONENT, MOTOR, REPLACEMENT ONLY                             Power wc motor replacement  32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E236900100PPOWER WHEELCHAIR COMPONENT, GEAR BOX, REPLACEMENT ONLY                          Pwr wc gear box replacement 32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E237000100PPOWER WHEELCHAIR COMPONENT, MOTOR AND GEAR BOX COMBINATION, REPLACEMENT ONLY    Pwr wc motor/gear box combo 32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E237100100PPOWER WHEELCHAIR ACCESSORY, GROUP 27 SEALED LEAD ACID BATTERY, (E.G. GEL CELL,  Gr27 sealed leadacid battery32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E237100200QABSORBED GLASSMAT), EACH                                                                                                                                                                                                                                                                                             
E237200100PPOWER WHEELCHAIR ACCESSORY, GROUP 27 NON-SEALED LEAD ACID BATTERY, EACH         Gr27 non-sealed leadacid    32      A                                                                                                     C                          D1D APR     2006010120060101        A                           
E239900100PPOWER WHEELCHAIR ACCESSORY, NOT OTHERWISE CLASSIFIED INTERFACE, INCLUDING ALL   Noc interface               32      A                                                                                                     C                          D1D APR     2004010120040101        N                           
E239900200QRELATED ELECTRONICS AND ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                   
E240200100PNEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE         Neg press wound therapy pump36      A                                                                                                     C                          D1E R       2004010120040101        N                           
E250000100PSPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES, LESS   SGD digitized pre-rec <=8min32      A60-23                                                                                                D                          D1E APR     2004010120040101        N                           
E250000200QTHAN OR EQUAL TO 8 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                            
E250200100PSPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec msg >8min <=20min32      A60-23                                                                                                D                          D1E APR     2004010120040101        N                           
E250200200QGREATER THAN 8 MINUTES BUT LESS THAN OR EQUAL TO 20 MINUTES RECORDING TIME                                                                                                                                                                                                                                           
E250400100PSPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec msg>20min <=40min32      A60-23                                                                                                D                          D1E APR     2004010120040101        N                           
E250400200QGREATER THAN 20 MINUTES BUT LESS THAN OR EQUAL TO 40 MINUTES RECORDING TIME                                                                                                                                                                                                                                          
E250600100PSPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec msg > 40 min     32      A60-23                                                                                                D                          D1E APR     2004010120040101        N                           
E250600200QGREATER THAN 40 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                               
E250800100PSPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, REQUIRING MESSAGE FORMULATION BY  SGD spelling phys contact   32      A60-23                                                                                                D                          D1E APR     2004010120040101        N                           
E250800200QSPELLING AND ACCESS BY PHYSICAL CONTACT WITH THE DEVICE                                                                                                                                                                                                                                                              
E251000100PSPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, PERMITTING MULTIPLE METHODS OF    SGD w multi methods msg/accs32      A60-23                                                                                                D                          D1E APR     2004010120040101        N                           
E251000200QMESSAGE FORMULATION AND MULTIPLE METHODS OF DEVICE ACCESS                                                                                                                                                                                                                                                            
E251100100PSPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL COMPUTER OR PERSONAL DIGITAL   SGD sftwre prgrm for PC/PDA 32      A60-23                                                                                                D                          D1E APR     2004010120040101        N                           
E251100200QASSISTANT                                                                                                                                                                                                                                                                                                            
E251200100PACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING SYSTEM                         SGD accessory, mounting sys 32      A60-23                                                                                                D                          D1E APR     2004010120040101        N                           
E259900100PACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERWISE CLASSIFIED                SGD accessory noc           32      A60-23                                                                                                D                          D1E APR     2004010120040101        N                           
E260100100PGENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH       Gen w/c cushion wdth < 22 in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E260200100PGENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH      Gen w/c cushion wdth >=22 in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E260300100PSKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH   Skin protect wc cus wd <22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E260400100PSKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH  Skin protect wc cus wd>=22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E260500100PPOSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH       Position wc cush wdth <22 in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E260600100PPOSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH      Position wc cush wdth>=22 in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E260700100PSKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22     Skin pro/pos wc cus wd <22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E260700200QINCHES, ANY DEPTH                                                                                                                                                                                                                                                                                                    
E260800100PSKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR     Skin pro/pos wc cus wd>=22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E260800200QGREATER, ANY DEPTH                                                                                                                                                                                                                                                                                                   
E260900100PCUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE                             Custom fabricate w/c cushion32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261000100PWHEELCHAIR SEAT CUSHION, POWERED                                                Powered w/c cushion         32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261100100PGENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS THAN 22 INCHES, ANY HEIGHT,     Gen use back cush wdth <22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261100200QINCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                 
E261200100PGENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCHES OR GREATER, ANY HEIGHT,    Gen use back cush wdth>=22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261200200QINCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                 
E261300100PPOSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH LESS THAN 22 INCHES, ANY  Position back cush wd <22in 32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261300200QHEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                         
E261400100PPOSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH 22 INCHES OR GREATER, ANY Position back cush wd>=22in 32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261400200QHEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                         
E261500100PPOSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH LESS THAN 22      Pos back post/lat wdth <22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261500200QINCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                             
E261600100PPOSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH 22 INCHES OR      Pos back post/lat wdth>=22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261600200QGREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                            
E261700100PCUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE         Custom fab w/c back cushion 32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261700200QMOUNTING HARDWARE                                                                                                                                                                                                                                                                                                    
E261800100PWHEELCHAIR ACCESSORY, SOLID SEAT SUPPORT BASE (REPLACES SLING SEAT), FOR USE    Wc acc solid seat supp base 32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E261800200QWITH MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, INCLUDES ANY TYPE                                                                                                                                                                                                                                            
E261800300QMOUNTING HARDWARE                                                                                                                                                                                                                                                                                                    
E261900100PREPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR BACK CUSHION, EACH             Replace cover w/c seat cush 32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E262000100PPOSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK WITH LATERAL SUPPORTS, WIDTH   WC planar back cush wd <22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E262000200QLESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                
E262100100PPOSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK WITH LATERAL SUPPORTS, WIDTH   WC planar back cush wd>=22in32      A                                                                                                     C                          D1D APR     2005010120050101        N                           
E262100200Q22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                               
E800000100PGAIT TRAINER, PEDIATRIC SIZE, POSTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND   Posterior gait trainer      00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
E800000200QCOMPONENTS                                                                                                                                                                                                                                                                                                           
E800100100PGAIT TRAINER, PEDIATRIC SIZE, UPRIGHT SUPPORT, INCLUDES ALL ACCESSORIES AND     Upright gait trainer        00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
E800100200QCOMPONENTS                                                                                                                                                                                                                                                                                                           
E800200100PGAIT TRAINER, PEDIATRIC SIZE, ANTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND    Anterior gait trainer       00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
E800200200QCOMPONENTS                                                                                                                                                                                                                                                                                                           
G000100100PROUTINE VENIPUNCTURE FOR COLLECTION OF SPECIMEN(S)                              Drawing blood for specimen  22      A                                                                                                     C                      0040T1A 5       199401012005010120041231N                           
G000200100POFFICE PROCEDURE, INSERTION OF TEMPORARY INDWELLING CATHETER, FOLEY TYPE        Temporary urinary catheter  11      A                                                                            5170251703               C                          P6C 2       199401012003010120021231N                           
G000200200Q(SEPARATE PROCEDURE)                                                                                                                                                                                                                                                                                                 
G000400100PPATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRE-SYMPTOM MEMORY LOOP  ECG transm phys review & int11      A50-15                                                                       93268                    D                          T2C 5       199501012003010120021231N                           
G000400200QAND 24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; INCLUDES TRANSMISSION,                                                                                                                                                                                                                                           
G000400300QPHYSICIAN REVIEW AND INTERPRETATION                                                                                                                                                                                                                                                                                  
G000500100PPATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRE-SYMPTOM MEMORY LOOP  ECG 24 hour recording       11      A50-15                                                                       93270                    D                          T2C 5       199501012003010120021231N                           
G000500200QAND 24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; RECORDING (INCLUDES                                                                                                                                                                                                                                              
G000500300QHOOK-UP, RECORDING AND DISCONNECTION)                                                                                                                                                                                                                                                                                
G000600100PPATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRE-SYMPTOM MEMORY LOOP  ECG transmission & analysis 11      A50-15                                                                       93271                    D                          T2C 5       199501012003010120021231N                           
G000600200QAND 24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; 24 HOUR ATTENDED                                                                                                                                                                                                                                                 
G000600300QMONITORING, RECEIPT OF TRANSMISSIONS, AND ANALYSIS                                                                                                                                                                                                                                                                   
G000700100PPATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRE-SYMPTON MEMORY LOOP  ECG phy review & interpret  11      A50-15                                                                       93272                    D                          T2C 5       199501012003010120021231N                           
G000700200QAND 24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; PHYSICIAN REVIEW AND                                                                                                                                                                                                                                             
G000700300QINTERPRETATION ONLY                                                                                                                                                                                                                                                                                                  
G000800100PADMINISTRATION OF INFLUENZA VIRUS VACCINE                                       Admin influenza virus vac   54      A                                                                                                     C                          O1G V       1994010119960101        N                           
G000900100PADMINISTRATION OF PNEUMOCOCCAL VACCINE                                          Admin pneumococcal vaccine  54      A                                                                                                     C                          O1G V       1994010119960101        N                           
G001000100PADMINISTRATION OF HEPATITIS B VACCINE                                           Admin hepatitis b vaccine   54      A                                                                                                     C                          O1G 1       1994010119960101        N                           
G001500100PPOST-SYMPTOM TELEPHONIC TRANSMISSION OF ELECTROCARDIOGRAM RHYTHM STRIP(S) AND   Post symptom ECG tracing    11      A50-15                                                                       93012                    D                          T2C 5       199501012003010120021231N                           
G001500200Q24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; TRACING ONLY                                                                                                                                                                                                                                                         
G002500100PCOLLAGEN SKIN TEST KIT                                                          Collagen skin test kit      00      9                                                                            Q3031                    I                          D1A S       199501012003040120030331N                           
G002600100PFECAL LEUCOCYTE EXAMINATION                                                     Fecal leukocyte examination 21      A                                                    400                                              C                          T1H 5       199501012003010120021231N                           
G002700100PSEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER              Semen analysis              21      A                                                    400                                              C                          T1H 5       1995010120031001        N                           
G003000100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); SINGLE PET imaging prev PET single 1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003000200QSTUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                
G003100100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047);        PET imaging prev PET multple1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003100200QMULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                     
G003200100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); SINGLE STUDY,  PET follow SPECT 78464 singl1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003200200QREST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                       
G003300100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); MULTIPLE       PET follow SPECT 78464 mult 1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003300200QSTUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                              
G003400100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); SINGLE       PET follow SPECT 76865 singl1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003400200QSTUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                
G003500100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); MULTIPLE     PET follow SPECT 78465 mult 1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003500200QSTUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                              
G003600100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY,              PET follow cornry angio sing1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003600200Q93510-93529); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                           
G003700100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY,              PET follow cornry angio mult1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003700200Q93510-93529); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                       
G003800100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL           PET follow myocard perf sing1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003800200QPERFUSION, 78460); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                      
G003900100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL           PET follow myocard perf mult1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G003900200QPERFUSION, 78460); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR                                                                                                                                                                                                                                                 
G003900300QPHARMACOLOGIC)                                                                                                                                                                                                                                                                                                       
G004000100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350);     PET follow stress echo singl1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G004000200QSINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                         
G004100100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350);     PET follow stress echo mult 1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G004100200QMULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                     
G004200100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM,     PET follow ventriculogm sing1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G004200200Q78481 OR 78483); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                        
G004300100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM,     PET follow ventriculogm mult1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G004300200Q78481 OR 78483); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR                                                                                                                                                                                                                                                   
G004300300QPHARMACOLOGIC)                                                                                                                                                                                                                                                                                                       
G004400100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); SINGLE STUDY,    PET following rest ECG singl1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G004400200QREST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                       
G004500100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); MULTIPLE         PET following rest ECG mult 1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G004500200QSTUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                              
G004600100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); SINGLE STUDY,  PET follow stress ECG singl 1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G004600200QREST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                       
G004700100PPET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); MULTIPLE       PET follow stress ECG mult  1113    B50-36                                                                                                D                          I4A 4       199501012005040120050331D                           
G004700200QSTUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                              
G005000100PMEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUNDResidual urine by ultrasound11      A                                                                            51798                    C                          I3F 4       199601012003010120021231N                           
G010100100PCERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION    CA screen;pelvic/breast exam11      A                                                                                                     D                      0064M1A 1       1998010119980101        N                           
G010200100PPROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINATION                           Prostate ca screening; dre  11      A50-55             4182                                                                               D                      0079Y1  1       2000010120000101        N                           
G010300100PPROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA), TOTAL          Psa, total screening        21      A50-55             4182                              310                                              D                      0079T1H 5       2000010120000101        N                           
G010400100PCOLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY                             CA screen;flexi sigmoidscope11      A                                                                                                     D                      0064P8C 2       1998010119980101        N                           
G010500100PCOLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK             Colorectal scrn; hi risk ind11      A                                                                                                     D0219980101            0064P8D 2       1998010119980101        N                           
G010600100PCOLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY,     Colon CA screen;barium enema11      A                                                                                                     D                      0064I1D 4       1998010119980101        N                           
G010600200QBARIUM ENEMA                                                                                                                                                                                                                                                                                                         
G010700100PCOLORECTAL CANCER SCREENING; FECAL-OCCULT BLOOD TEST, 1-3 SIMULTANEOUS          CA screen; fecal blood test 21      A                                                                                                     D                      0064T1H 5       1998010119980101        N                           
G010700200QDETERMINATIONS                                                                                                                                                                                                                                                                                                       
G010800100PDIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30       Diab manage trn  per indiv  11      A                                                                                                     C                      0071Y1  1       1998070120010101        N                           
G010800200QMINUTES                                                                                                                                                                                                                                                                                                              
G010900100PDIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION (2 OR      Diab manage trn ind/group   11      A                                                                                                     C                      0071Y1  1       1998070120010101        N                           
G010900200QMORE), PER 30 MINUTES                                                                                                                                                                                                                                                                                                
G011000100PNETT PULM-REHAB; EDUCATION/SKILLS TRAINING, INDIVIDUAL                          Nett pulm-rehab educ; ind   11      A35-93                                                                                                D                      0065P6C 1       199708012006010120051231D                           
G011100100PNETT PULM-REHAB; EDUCATION/SKILLS TRAINING, GROUP                               Nett pulm-rehab educ; group 11      A35-93                                                                                                D                      0065P6C 1       199708012006010120051231D                           
G011200100PNETT PULM-REHAB; NUTRITIONAL GUIDANCE, INITIAL                                  Nett;nutrition guid, initial11      A35-93                                                                                                D                      0065P6C 1       199708012006010120051231D                           
G011300100PNETT PULM-REHAB; NUTRITIONAL GUIDANCE, SUBSEQUENT                               Nett;nutrition guid,subseqnt11      A35-93                                                                                                D                      0065P6C 1       199708012006010120051231D                           
G011400100PNETT PULM-REHAB; PSYCHOSOCIAL CONSULTATION                                      Nett; psychosocial consult  11      A35-93                                                                                                D                      0065Y1  3       199708012006010120051231D                           
G011500100PNETT PULM-REHAB; PSYCHOLOGICAL TESTING                                          Nett; psychological testing 11      A35-93                                                                                                D                      0065Y1  1T      199708012006010120051231D                           
G011600100PNETT PULM-REHAB; PSYCHOSOCIAL COUNSELLING                                       Nett; psychosocial counsel  11      A35-93                                                                                                D                      0065Y1  1T      199708012006010120051231D                           
G011700100PGLAUCOMA SCREENING FOR HIGH RISK PATIENTS FURNISHED BY AN OPTOMETRIST OR        Glaucoma scrn hgh risk direc11      A                                                                                                     C                          T2D Q       2002010120031001        N                           
G011700200QOPHTHALMOLOGIST                                                                                                                                                                                                                                                                                                      
G011800100PGLAUCOMA SCREENING FOR HIGH RISK PATIENT FURNISHED UNDER THE DIRECT SUPERVISION Glaucoma scrn hgh risk direc11      A                                                                                                     C                          T2D Q       2002010120031001        N                           
G011800200QOF AN OPTOMETRIST OR OPHTHALOMOLOGIST                                                                                                                                                                                                                                                                                
G012000100PCOLORECTAL CANCER SCREENING; ALTERNATIVE TO G0105, SCREENING COLONOSCOPY,       Colon ca scrn; barium enema 11      A                                                                                                     D                      0064I1D 4       1998010119980101        N                           
G012000200QBARIUM ENEMA.                                                                                                                                                                                                                                                                                                        
G012100100PCOLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR Colon ca scrn not hi rsk ind11      A                                                                                                     D0220010701            0064I1D 2       1998010120010701        N                           
G012100200QHIGH RISK                                                                                                                                                                                                                                                                                                            
G012200100PCOLORECTAL CANCER SCREENING; BARIUM ENEMA                                       Colon ca scrn; barium enema 00      9                                                                                                     M                      0064I1D 4       1998010119980101        N                           
G012300100PSCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Screen cerv/vag thin layer  21      A50-20                                               630                                              D                      0045T1H 5       1998040119980401        N                           
G012300200QIN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, SCREENING BY                                                                                                                                                                                                                                                
G012300300QCYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                                         
G012400100PSCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Screen c/v thin layer by MD 1121    C50-20                                               630                                              D                      0045T1H 5       1998040119980401        N                           
G012400200QIN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, REQUIRING                                                                                                                                                                                                                                                   
G012400300QINTERPRETATION BY PHYSICIAN                                                                                                                                                                                                                                                                                          
G012500100PPET IMAGING REGIONAL OR WHOLE BODY; SINGLE PULMONARY NODULE                     PET image pulmonary nodule  11      A50-36             4173                                                                               D                          I2D 4       199712182005040120050331D                           
G012700100PTRIMMING OF DYSTROPHIC NAILS, ANY NUMBER                                        Trim nail(s)                11      A                  2323    4120                                                                       D                          P5A 2       1998010119980101        N                           
G012800100PDIRECT (FACE-TO-FACE WITH PATIENT) SKILLED NURSING SERVICES OF A REGISTERED     CORF skilled nursing service99      9                                          1833(a)                                                    D                      0070Y2  1       1998040119980401        N                           
G012800200QNURSE PROVIDED IN A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY, EACH 10                                                                                                                                                                                                                                        
G012800300QMINUTES BEYOND THE FIRST 5 MINUTES                                                                                                                                                                                                                                                                                   
G012900100POCCUPATIONAL THERAPY REQUIRING THE SKILLS OF A QUALIFIED OCCUPATIONAL           Partial hosp prog service   00      9                                                                                                     C                      0087Y1  U       2000040120000401        N                           
G012900200QTHERAPIST, FURNISHED AS A COMPONENT OF A PARTIAL HOSPITALIZATION TREATMENT                                                                                                                                                                                                                                           
G012900300QPROGRAM, PER DAY                                                                                                                                                                                                                                                                                                     
G013000100PSINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DENSITY STUDY, ONE OR MORE       Single energy x-ray study   11      A50-44                                                                                                D                          I4B 4       1998070119980701        N                           
G013000200QSITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)                                                                                                                                                                                                                                                  
G013100100PCOMPUTERIZED TOMOGRAPHY BONE MINERAL DENSITY STUDY, ONE OR MORE SITES; AXIAL    CT scan, bone density study 11      A50-44                                                                       76070                    D                          I2B 4       199807012003010120021231N                           
G013100200QSKELETON (EG, HIPS, PELVIS, SPINE)                                                                                                                                                                                                                                                                                   
G013200100PCOMPUTERIZED TOMOGRAPHY BONE MINERAL DENSITY STUDY, ONE OR MORE SITES;          CT scan, bone density study 11      A50-44                                                                       76071                    D                          I2B 4       199807012003010120021231N                           
G013200200QAPPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)                                                                                                                                                                                                                                                         
G014100100PSCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED     Scr c/v cyto,autosys and md 11      A                                                    630                                              C                      0045T1H 5       1999010119990101        N                           
G014100200QSYSTEM, WITH MANUAL RESCREENING, REQUIRING INTERPRETATION BY PHYSICIAN                                                                                                                                                                                                                                               
G014300100PSCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5       1999010119990101        N                           
G014300200QIN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH MANUAL SCREENING                                                                                                                                                                                                                                       
G014300300QAND RESCREENING BY CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                      
G014400100PSCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5       1999010120030101        N                           
G014400200QIN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH  SCREENING BY                                                                                                                                                                                                                                          
G014400300QAUTOMATED SYSTEM, UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                                        
G014500100PSCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5       1999010120030101        N                           
G014500200QIN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH  SCREENING BY                                                                                                                                                                                                                                          
G014500300QAUTOMATED SYSTEM AND MANUAL RESCREENING UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                  
G014700100PSCREENING CYTOPATHOLOGY SMEARS,  CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED    Scr c/v cyto, automated sys 21      A                                                    630                                              C                      0045T1H 5       1999010119990101        N                           
G014700200QSYSTEM UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                                                   
G014800100PSCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED     Scr c/v cyto, autosys, rescr21      A                                                    630                                              C                      0045T1H 5       1999010119990101        N                           
G014800200QSYSTEM WITH MANUAL RESCREENING                                                                                                                                                                                                                                                                                       
G015100100PSERVICES OF PHYSICAL THERAPIST IN HOME HEALTH SETTING, EACH 15 MINUTES          HHCP-serv of pt,ea 15 min   00      9                                                                                                     C                      0082Y2  1       1999070119990701        N                           
G015200100PSERVICES OF OCCUPATIONAL THERAPIST IN HOME HEALTH SETTING, EACH 15 MINUTES      HHCP-serv of ot,ea 15 min   00      9                                                                                                     C                      0082Y2  1       1999070119990701        N                           
G015300100PSERVICES OF SPEECH AND LANGUAGE PATHOLOGIST IN HOME HEALTH SETTING, EACH 15     HHCP-svs of s/l path,ea 15mn00      9                                                                                                     C                      0082Y2  1       1999070119990701        N                           
G015300200QMINUTES                                                                                                                                                                                                                                                                                                              
G015400100PSERVICES OF SKILLED NURSE IN HOME HEALTH SETTING, EACH 15 MINUTES               HHCP-svs of rn,ea 15 min    00      9                                                                                                     C                      0082Y2  1       1999070119990701        N                           
G015500100PSERVICES OF CLINICAL SOCIAL WORKER IN HOME HEALTH SETTING, EACH 15 MINUTES      HHCP-svs of csw,ea 15 min   00      9                                                                                                     C                      0082Y2  1       1999070119990701        N                           
G015600100PSERVICES OF HOME HEALTH AIDE IN HOME HEALTH SETTING, EACH 15 MINUTES            HHCP-svs of aide,ea 15 min  00      9                                                                                                     C                      0082Y2  1       1999070119990701        N                           
G016600100PEXTERNAL COUNTERPULSATION, PER TREATMENT SESSION                                Extrnl counterpulse, per tx 11      A35-74                                                                                                D                      0078P6C 1       2000010120000101        N                           
G016700100PHYPERBARIC OXYGEN TREATMENT NOT REQUIRING PHYSICIAN ATTENDANCE, PER TREATMENT   Hyperbaric oz tx;no md reqrd11      A                                                                                                     G                          P6C 1       200001012004010120031231N                           
G016700200QSESSION                                                                                                                                                                                                                                                                                                              
G016800100PWOUND CLOSURE UTILIZING TISSUE ADHESIVE(S) ONLY                                 Wound closure by adhesive   00      9                                                                                                     C                          P6C 1       2000010120000101        N                           
G017300100PLINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY, COMPLETE COURSE OF THERAPY  Linear acc stereo radsur com00      9                                                                                                     D                      0094P5E 2       2000080120050101        N                           
G017300200QIN ONE SESSION                                                                                                                                                                                                                                                                                                       
G017500100PSCHEDULED INTERDISCIPLINARY TEAM CONFERENCE (MINIMUM OF THREE EXCLUSIVE OF      OPPS Service,sched team conf00      9                                                                                                     C                      0101M6  1       2000070120000701        N                           
G017500200QPATIENT CARE NURSING STAFF) WITH PATIENT PRESENT                                                                                                                                                                                                                                                                     
G017600100PACTIVITY THERAPY, SUCH AS MUSIC, DANCE, ART OR PLAY THERAPIES NOT FOR           OPPS/PHP;activity therapy   00      9                                                                                                     D                      0102Y2  U       2001010120010101        N                           
G017600200QRECREATION, RELATED TO THE CARE AND TREATMENT OF PATIENT'S DISABLING MENTAL                                                                                                                                                                                                                                          
G017600300QHEALTH PROBLEMS, PER SESSION (45 MINUTES OR MORE)                                                                                                                                                                                                                                                                    
G017700100PTRAINING AND EDUCATIONAL SERVICES RELATED TO THE CARE AND TREATMENT OF          OPPS/PHP; train & educ serv 00      9                                                                                                     D                      0102Y2  U       2001010120010101        N                           
G017700200QPATIENT'S DISABLING MENTAL HEALTH PROBLEMS PER SESSION (45 MINUTES OR MORE)                                                                                                                                                                                                                                          
G017900100PPHYSICIAN RE-CERTIFICATION FOR MEDICARE-COVERED HOME HEALTH  SERVICES UNDER A   MD recertification HHA PT   11      A                                                                                                     C                          Y1  1       2001010120010101        N                           
G017900200QHOME HEALTH PLAN OF CARE (PATIENT NOT PRESENT), INCLUDING CONTACTS WITH HOME                                                                                                                                                                                                                                         
G017900300QHEALTH AGENCY AND REVIEW OF REPORTS OF PATIENT STATUS REQUIRED BY PHYSICIANS TO                                                                                                                                                                                                                                      
G017900400QAFFIRM THE INITIAL IMPLEMENTATION OF THE PLAN OF CARE THAT MEETS PATIENT'S                                                                                                                                                                                                                                           
G017900500QNEEDS, PER RE-CERTIFICATION PERIOD                                                                                                                                                                                                                                                                                   
G018000100PPHYSICIAN CERTIFICATION FOR MEDICARE-COVERED HOME HEALTH  SERVICES UNDER A HOME MD certification HHA patient11      A                                                                                                     C                      0100Y1  1       2000100120001001        N                           
G018000200QHEALTH PLAN OF CARE (PATIENT NOT PRESENT), INCLUDING CONTACTS WITH HOME HEALTH                                                                                                                                                                                                                                       
G018000300QAGENCY AND REVIEW OF REPORTS OF PATIENT STATUS REQUIRED BY PHYSICIANS TO AFFIRM                                                                                                                                                                                                                                      
G018000400QTHE INITIAL IMPLEMENTATION OF THE PLAN OF CARE THAT MEETS PATIENT'S NEEDS, PER                                                                                                                                                                                                                                       
G018000500QCERTIFICATION PERIOD                                                                                                                                                                                                                                                                                                 
G018100100PPHYSICIAN SUPERVISION OF A PATIENT RECEIVING MEDICARE-COVERED SERVICES PROVIDED Home health care supervision11      A                                                                                                     C                          Y1  1       2001010120010101        N                           
G018100200QBY A PARTICIPATING HOME HEALTH AGENCY (PATIENT NOT PRESENT) REQUIRING COMPLEX                                                                                                                                                                                                                                        
G018100300QAND MULTIDISCIPLINARY CARE MODALITIES INVOLVING REGULAR PHYSICIAN DEVELOPMENT                                                                                                                                                                                                                                        
G018100400QAND/OR REVISION OF CARE PLANS, REVIEW OF SUBSEQUENT REPORTS OF PATIENT STATUS,                                                                                                                                                                                                                                       
G018100500QREVIEW OF LABORATORY AND OTHER STUDIES, COMMUNICATION (INCLUDING TELEPHONE                                                                                                                                                                                                                                           
G018100600QCALLS) WITH OTHER HEALTH CARE PROFESSIONALS INVOLVED IN THE PATIENT'S CARE,                                                                                                                                                                                                                                          
G018100700QINTEGRATION OF NEW INFORMATION INTO THE MEDICAL TREATMENT PLAN AND/OR                                                                                                                                                                                                                                                
G018100800QADJUSTMENT OF MEDICAL THERAPY, WITHIN A CALENDAR MONTH, 30 MINUTES OR MORE                                                                                                                                                                                                                                           
G018200100PPHYSICIAN SUPERVISION OF A PATIENT UNDER A MEDICARE-APPROVED HOSPICE (PATIENT   Hospice care supervision    11      A                                                                                                     C                          Y1  1       2001010120010101        N                           
G018200200QNOT PRESENT) REQUIRING COMPLEX AND MULTIDISCIPLINARY CARE MODALITIES INVOLVING                                                                                                                                                                                                                                       
G018200300QREGULAR PHYSICIAN DEVELOPMENT AND/OR REVISION OF CARE PLANS, REVIEW OF                                                                                                                                                                                                                                               
G018200400QSUBSEQUENT REPORTS OF PATIENT STATUS, REVIEW OF LABORATORY AND OTHER STUDIES,                                                                                                                                                                                                                                        
G018200500QCOMMUNICATION (INCLUDING TELEPHONE CALLS) WITH OTHER HEALTH CARE PROFESSIONALS                                                                                                                                                                                                                                       
G018200600QINVOLVED IN THE PATIENT'S CARE, INTEGRATION OF NEW INFORMATION INTO THE MEDICAL                                                                                                                                                                                                                                      
G018200700QTREATMENT PLAN AND/OR ADJUSTMENT OF MEDICAL THERAPY, WITHIN A CALENDAR MONTH,                                                                                                                                                                                                                                        
G018200800Q30 MINUTES OR MORE                                                                                                                                                                                                                                                                                                   
G018500100PDESTRUCTION OF LOCALIZED LESION OF CHOROID (FOR EXAMPLE, CHOROIDAL              Transpuppillary thermotx    00      9                                                                            0016T                    C                      0099P4D 2       200101012003010120021231N                           
G018500200QNEOVASCULARIZATION); TRANSPUPILLARY THERMOTHERAPY (ONE OR MORE SESSIONS)                                                                                                                                                                                                                                             
G018600100PDESTRUCTION OF LOCALIZED LESION OF CHOROID (FOR EXAMPLE, CHOROIDAL              Dstry eye lesn,fdr vssl tech00      9                                                                                                     C                      0099P4D 2       2001010120010101        N                           
G018600200QNEOVASCULARIZATION); PHOTOCOAGULATION, FEEDER VESSEL TECHNIQUE (ONE OR MORE                                                                                                                                                                                                                                          
G018600300QSESSIONS)                                                                                                                                                                                                                                                                                                            
G018700100PDESTRUCTION OF MACULAR DRUSEN, PHOTOCOAGULATION (ONE OR MORE SESSIONS)          Dstry mclr drusen,photocoag 00      9                                                                                                     C                      0099P4D 2       200101012003010120021231N                           
G019200100PINTRANASAL OR ORAL ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION           Immunization oral/intranasal00      9                  2049.4  2320                                                                       M                          P6C 1       200101012003010120021231N                           
G019200200QVACCINE/TOXOID)                                                                                                                                                                                                                                                                                                      
G019300100PENDOSCOPIC STUDY OF SWALLOWING FUNCTION (ALSO FIBEROPTIC ENDOSCOPIC EVALUATION  Endoscopicstudyswallowfunctn11      A                                                                            92612                    C                          Y1  1       200101012003010120021231N                           
G019300200QOF SWALLOWING (FEES)                                                                                                                                                                                                                                                                                                 
G019400100PSENSORY TESTING DURING ENDOSCOPIC STUDY OF SWALLOWING (ADD ON CODE)  REFERRED   Sensorytestingendoscopicstud11      A                                                                            92614                    C                          Y1  1       200101012003010120021231N                           
G019400200QTO AS FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING WITH SENSORY TESTING                                                                                                                                                                                                                                            
G019400300Q(FEEST)                                                                                                                                                                                                                                                                                                              
G019500100PCLINICAL EVALUATION OF SWALLOWING FUNCTION (NOT INVOLVING INTERPRETATION OF     Clinicalevalswallowingfunct 11      A                                                                            92610                    C                          Y1  1       200101012003010120021231N                           
G019500200QDYNAMIC RADIOLOGICAL STUDIES OR ENDOSCOPIC STUDY OF SWALLOWING)                                                                                                                                                                                                                                                      
G019600100PEVALUATION OF SWALLOWING INVOLVING SWALLOWING OF RADIO-OPAQUE MATERIALS         Evalofswallowingwithradioopa11      A                                                                            92611                    C                          Y1  1       200101012003010120021231N                           
G019700100PEVALUATION OF PATIENT FOR PRESCRIPTION OF SPEECH GENERATING DEVICES             Evalofptforprescipspeechdevi11      A                                                                            92607                    C                          Y1  1       200101012003010120021231N                           
G019800100PPATIENT ADAPTATION AND TRAINING FOR USE OF SPEECH GENERATING DEVICES            Patientadapation&trainforspe11      A                                                                            92609                    C                          Y1  1       200101012003010120021231N                           
G019900100PRE-EVALUATION OF PATIENT USING SPEECH GENERATING DEVICES                        Reevaluationofpatientusespec11      A                                                                            9260792608               C                          Y1  1       200101012003010120021231N                           
G020000100PEVALUATION OF PATIENT FOR PRESCRIPTION OF VOICE PROSTHETIC                      Evalofpatientprescipofvoicep11      A                                                                            92506                    C                          Y1  1       200101012003010120021231N                           
G020100100PMODIFICATION OR TRAINING IN USE OF VOICE PROSTHETIC                             Modifortraininginusevoicepro11      A                                                                            92507                    C                          Y1  1       200101012003010120021231N                           
G020200100PSCREENING MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS     Screeningmammographydigital 11      A                                                                                                     C                          I1C 1       2001040120010401        N                           
G020400100PDIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS    Diagnosticmammographydigital11      A                                                                                                     C                          I1C 4       2001040120030101        N                           
G020600100PDIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, UNILATERAL, ALL VIEWS   Diagnosticmammographydigital11      A                                                                                                     C                          I1C 4       2001040120030101        N                           
G021000100PPET IMAGING WHOLE BODY; DIAGNOSIS; LUNG CANCER, NON-SMALL CELL                  PET img wholebody dxlung    11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G021100100PPET IMAGING WHOLE BODY; INITIAL STAGING; LUNG CANCER; NON-SMALL CELL (REPLACES  PET img wholbody init lung  11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G021100200QG0126)                                                                                                                                                                                                                                                                                                               
G021200100PPET IMAGING WHOLE BODY; RESTAGING; LUNG CANCER; NON-SMALL                       PET img wholebod restag lung11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G021300100PPET IMAGING WHOLE BODY; DIAGNOSIS; COLORECTAL                                   PET img wholbody dx         11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G021400100PPET IMAGING WHOLE BODY; INITIAL STAGING; COLORECTAL                             PET img wholebod init       11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G021500100PPET IMAGING WHOLE BODY; RESTAGING; COLORECTAL CANCER (REPLACES G0163)           PETimg wholebod restag      11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G021600100PPET IMAGING WHOLE BODY; DIAGNOSIS; MELANOMA                                     PET img wholebod dx melanoma11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G021700100PPET IMAGING WHOLE BODY; INITIAL STAGING; MELANOMA                               PET img wholebod init melan 11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G021800100PPET IMAGING WHOLE BODY; RESTAGING; MELANOMA (REPLACES G0165)                    PET img wholebod restag mela11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G021900100PPET IMAGING WHOLE BODY; MELANOMA FOR NON-COVERED INDICATIONS                    PET img wholbod melano nonco00      950-36             4173                                                                               M                          I4B 4       2001070120010701        N                           
G022000100PPET IMAGING WHOLE BODY; DIAGNOSIS; LYMPHOMA                                     PET img wholebod dx lymphoma11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022100100PPET IMAGING WHOLE BODY; INITIAL STAGING; LYMPHOMA (REPLACES G0164)              PET imag wholbod init lympho11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022200100PPET IMAGING WHOLE BODY; RESTAGING; LYMPHOMA (REPLACES G0164)                    PET imag wholbod resta lymph11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022300100PPET IMAGING WHOLE BODY OR REGIONAL; DIAGNOSIS; HEAD AND NECK CANCER; EXCLUDING  PET imag wholbod reg dx head11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022300200QTHYROID AND CNS CANCERS                                                                                                                                                                                                                                                                                              
G022400100PPET IMAGING WHOLE BODY OR REGIONAL; INITIAL STAGING; HEAD AND NECK CANCER;      PET imag wholbod reg ini hea11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022400200QEXCLUDING THYROID AND CNS CANCERS                                                                                                                                                                                                                                                                                    
G022500100PPET IMAGING WHOLE BODY OR REGIONAL; RESTAGING; HEAD AND NECK CANCER, EXCLUDING  PET whol restag headneckonly11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022500200QTHYROID AND CNS CANCERS                                                                                                                                                                                                                                                                                              
G022600100PPET IMAGING WHOLE BODY; DIAGNOSIS; ESOPHAGEAL CANCER                            PET img wholbody dx esophagl11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022700100PPET IMAGING WHOLE BODY; INITIAL STAGING; ESOPHAGEAL CANCER                      PET img wholbod ini esophage11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022800100PPET IMAGING WHOLE BODY; RESTAGING; ESOPHAGEAL CANCER                            PET img wholbod restg esopha11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022900100PPET IMAGING; METABOLIC BRAIN IMAGING FOR PRE-SURGICAL EVALUATION OF REFRACTORY  PET img metaboloc brain pres11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G022900200QSEIZURES                                                                                                                                                                                                                                                                                                             
G023000100PPET IMAGING; METABOLIC ASSESSMENT FOR MYOCARDIAL VIABILITY FOLLOWING            PET myocard viability post  11      A50-36             4173                                                                               D                          I4B 4       200107012005040120050331D                           
G023000200QINCONCLUSIVE SPECT  STUDY                                                                                                                                                                                                                                                                                            
G023100100PPET, WHOLE BODY, FOR RECURRENCE OF COLORECTAL OR COLORECTAL METASTATIC CANCER;  PET WhBD colorec; gamma cam 11      A50-36                                                                                                D                          I4B 4       200201012005040120050331D                           
G023100200QGAMMA CAMERAS ONLY                                                                                                                                                                                                                                                                                                   
G023200100PPET, WHOLE BODY, FOR STAGING AND CHARACTERIZATION OF LYMPHOMA; GAMMA CAMERAS    PET whbd lymphoma; gamma cam11      A50-36                                                                                                D                          I4B 4       200201012005040120050331D                           
G023200200QONLY                                                                                                                                                                                                                                                                                                                 
G023300100PPET, WHOLE BODY, FOR RECURRENCE OF MELANOMA OR MELANOMA METASTATIC CANCER;      PET whbd melanoma; gamma cam11      A50-36                                                                                                D                          I4B 4       200201012005040120050331D                           
G023300200QGAMMA CAMERAS ONLY                                                                                                                                                                                                                                                                                                   
G023400100PPET, REGIONAL OR WHOLE BODY, FOR SOLITARY PULMONARY NODULE FOLLOWING CT OR FOR  PET WhBD pulm nod; gamma cam11      A50-36                                                                                                D                          I4B 4       200201012005040120050331D                           
G023400200QINITIAL STAGING OF PATHOLOGICALLY DIAGNOSED NONSMALL CELL LUNG CANCER; GAMMA                                                                                                                                                                                                                                         
G023400300QCAMERAS ONLY                                                                                                                                                                                                                                                                                                         
G023500100PPET IMAGING, ANY SITE, NOT OTHERWISE SPECIFIED                                  PET not otherwise specified 00      950-36                                                                                                M                          T2D 1       2006010120060101        A                           
G023600100PDIGITIZATION OF FILM RADIOGRAPHIC IMAGES WITH COMPUTER ANALYSIS FOR LESION      Digital film convert diag ma11      A                                                                                                     C                          I4B 4       200201012004010120031231N                           
G023600200QDETECTION, OR COMPUTER ANALYSIS OF DIGITAL MAMMOGRAM FOR LESION DETECTION, AND                                                                                                                                                                                                                                       
G023600300QFURTHER PHYSICIAN REVIEW FOR INTERPRETATION, DIAGNOSTIC MAMMOGRAPHY (LIST                                                                                                                                                                                                                                            
G023600400QSEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                
G023700100PTHERAPEUTIC PROCEDURES TO INCREASE STRENGTH OR ENDURANCE OF RESPIRATORY         Therapeutic procd strg endur11      A                                                                                                     C                          P6C 1UW     2002010120041001        N                           
G023700200QMUSCLES, FACE TO FACE, ONE ON ONE, EACH 15 MINUTES (INCLUDES MONITORING)                                                                                                                                                                                                                                             
G023800100PTHERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY FUNCTION, OTHER THAN DESCRIBED BY Oth resp proc, indiv        11      A                                                                                                     C                          P6C 1UW     2002010120041001        N                           
G023800200QG0237, ONE ON ONE, FACE TO FACE, PER 15 MINUTES (INCLUDES MONITORING)                                                                                                                                                                                                                                                
G023900100PTHERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY FUNCTION OR INCREASE STRENGTH OR  Oth resp proc, group        11      A                                                                                                     C                          P6C 1UW     2002010120041001        N                           
G023900200QENDURANCE OF RESPIRATORY MUSCLES, TWO OR MORE INDIVIDUALS (INCLUDES MONITORING)                                                                                                                                                                                                                                      
G024000100PCRITICAL CARE SERVICE DELIVERED BY A PHYSICIAN, FACE TO FACE; DURING            Critic care by MD transport 11      A                                                                                                     C                          O1A 1       200201012003010120021231N                           
G024000200QINTERFACILITY TRANSPORT OF A CRITICALLY ILL OR CRITICALLY INJURED PATIENT;                                                                                                                                                                                                                                           
G024000300QFIRST 30-74 MINUTES OF ACTIVE TRANSPORT                                                                                                                                                                                                                                                                              
G024100100PEACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO G0240)               Each additional 30 minutes  11      A                                                                                                     C                          O1A 1       200201012003010120021231N                           
G024200100PMULTI-SOURCE PHOTON STEREOTACTIC RADIOSURGERY (COBALT 60 MULTI-SOURCE           Multisource photon ster plan00      9                                                                                                     D                      0094P5E 2       200201012006010120051231D                           
G024200200QCONVERGING BEAMS) PLAN, INCLUDING DOSE VOLUME HISTOGRAMS FOR TARGET AND                                                                                                                                                                                                                                              
G024200300QCRITICAL STRUCTURE TOLERANCES, PLAN OPTIMIZATION PERFORMED FOR HIGHLY CONFORMAL                                                                                                                                                                                                                                      
G024200400QDISTRIBUTIONS, PLAN POSITIONAL ACCURACY AND DOSE VERIFICATION, ALL LESIONS                                                                                                                                                                                                                                           
G024200500QTREATED, PER COURSE OF TREATMENT                                                                                                                                                                                                                                                                                     
G024300100PMULTI-SOURCE PHOTON STEREOTACTIC RADIOSURGERY, DELIVERY INCLUDING COLLIMATOR    Multisour photon stero treat00      9                                                                                                     D                      0094P5E 2       2002010120020101        N                           
G024300200QCHANGES AND CUSTOM PLUGGING, COMPLETE COURSE OF TREATMENT, ALL LESIONS                                                                                                                                                                                                                                               
G024400100POBSERVATION CARE PROVIDED BY A FACILITY TO A PATIENT WITH CHF, CHEST PAIN, OR   Observ care by facility topt00      9                                                                                                     D                      0107M2A 1       200201012006010120051231D                           
G024400200QASTHMA, MINIMUM EIGHT HOURS                                                                                                                                                                                                                                                                                          
G024500100PINITIAL PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH DIABETIC Initial foot exam pt lops   11      A50.81                                                                                                D                          M1A 1       2002070120020701        N                           
G024500200QSENSORY NEUROPATHY RESULTING IN A LOSS OF PROTECTIVE SENSATION (LOPS) WHICH                                                                                                                                                                                                                                          
G024500300QMUST INCLUDE: (1) THE DIAGNOSIS OF LOPS, (2) A PATIENT HISTORY, (3) A PHYSICAL                                                                                                                                                                                                                                       
G024500400QEXAMINATION THAT CONSISTS OF AT LEAST THE FOLLOWING ELEMENTS: (A) VISUAL                                                                                                                                                                                                                                             
G024500500QINSPECTION OF THE FOREFOOT, HINDFOOT AND TOE WEB SPACES, (B)EVALUATION OF A                                                                                                                                                                                                                                          
G024500600QPROTECTIVE SENSATION, (C) EVALUATION OF FOOT STRUCTURE AND BIOMECHANICS, (D)                                                                                                                                                                                                                                         
G024500700QEVALUATION OF VASCULAR STATUS AND SKIN INTEGRITY, AND (E) EVALUATION AND                                                                                                                                                                                                                                             
G024500800QRECOMMENDATION OF FOOTWEAR AND (4) PATIENT EDUCATION                                                                                                                                                                                                                                                                 
G024600100PFOLLOW-UP PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH        Followup eval of foot pt lop11      A50.81                                                                                                D                          M1B 1       2002070120020701        N                           
G024600200QDIABETIC SENSORY NEUROPATHY RESULTING IN A LOSS OF PROTECTIVE SENSATION (LOPS)                                                                                                                                                                                                                                       
G024600300QTO INCLUDE AT LEAST THE FOLLOWING: (1) A PATIENT HISTORY, (2) A PHYSICAL                                                                                                                                                                                                                                             
G024600400QEXAMINATION THAT INCLUDES: (A) VISUAL INSPECTION OF THE FOREFOOT, HINDFOOT AND                                                                                                                                                                                                                                       
G024600500QTOE WEB SPACES, (B) EVALUATION OF PROTECTIVE SENSATION, (C) EVALUATION OF FOOT                                                                                                                                                                                                                                       
G024600600QSTRUCTURE AND BIOMECHANICS, (D) EVALUATION OF VASCULAR STATUS AND SKIN                                                                                                                                                                                                                                               
G024600700QINTEGRITY, AND (E) EVALUATION AND RECOMMENDATION OF FOOTWEAR, AND (3) PATIENT                                                                                                                                                                                                                                        
G024600800QEDUCATION                                                                                                                                                                                                                                                                                                            
G024700100PROUTINE FOOT CARE BY A PHYSICIAN OF A DIABETIC PATIENT WITH DIABETIC SENSORY    Routine footcare pt w lops  11      A50.81                                                                                                D                          M1B 1       2002070120030701        N                           
G024700200QNEUROPATHY RESULTING IN A LOSS OF PROTECTIVE SENSATION (LOPS) TO INCLUDE, THE                                                                                                                                                                                                                                        
G024700300QLOCAL CARE OF SUPERFICIAL WOUNDS (I.E. SUPERFICIAL TO MUSCLE AND FASCIA) AND AT                                                                                                                                                                                                                                      
G024700400QLEAST THE FOLLOWING IF PRESENT: (1) LOCAL CARE OF SUPERFICIAL WOUNDS, (2)                                                                                                                                                                                                                                            
G024700500QDEBRIDEMENT OF CORNS AND CALLUSES, AND (3) TRIMMING AND DEBRIDEMENT OF NAILS                                                                                                                                                                                                                                         
G024800100PDEMONSTRATION, AT INITIAL USE, OF HOME INR MONITORING FOR PATIENT WITH          Demonstrate use home inr mon11      A50.55                                                                                                D                          M1A 5       2002070120020701        N                           
G024800200QMECHANICAL HEART VALVE(S) WHO MEETS MEDICARE COVERAGE CRITERIA, UNDER THE                                                                                                                                                                                                                                            
G024800300QDIRECTION OF A PHYSICIAN; INCLUDES: DEMONSTRATING USE AND CARE OF THE INR                                                                                                                                                                                                                                            
G024800400QMONITOR, OBTAINING AT LEAST ONE BLOOD SAMPLE, PROVISION OF INSTRUCTIONS FOR                                                                                                                                                                                                                                          
G024800500QREPORTING HOME INR TEST RESULTS, AND DOCUMENTATION OF PATIENT ABILITY TO                                                                                                                                                                                                                                             
G024800600QPERFORM TESTING                                                                                                                                                                                                                                                                                                      
G024900100PPROVISION OF TEST MATERIALS AND EQUIPMENT FOR HOME INR MONITORING TO PATIENT    Provide test material,equipm11      A50.55                                                                                                D                          Y1  5       2002070120020701        N                           
G024900200QWITH MECHANICAL HEART VALVE(S) WHO MEETS MEDICARE COVERAGE CRITERIA; INCLUDES                                                                                                                                                                                                                                        
G024900300QPROVISION OF MATERIALS FOR USE IN THE HOME AND REPORTING OF TEST RESULTS TO                                                                                                                                                                                                                                          
G024900400QPHYSICIAN; PER 4 TESTS                                                                                                                                                                                                                                                                                               
G025000100PPHYSICIAN REVIEW, INTERPRETATION AND PATIENT MANAGEMENT OF HOME INR TESTING FOR MD review interpret of test 11      A50.55                                                                                                D                          M1B 1       2002070120020701        N                           
G025000200QA PATIENT WITH MECHANICAL HEART VALVE(S) WHO MEETS OTHER COVERAGE CRITERIA; PER                                                                                                                                                                                                                                      
G025000300Q4 TESTS (DOES NOT REQUIRE FACE-TO-FACE SERVICE)                                                                                                                                                                                                                                                                      
G025100100PLINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY, DELIVERY INCLUDING          Linear acc based stero radio00      9                                                                                                     D                      0107I1F 4       2002040120020401        N                           
G025100200QCOLLIMATOR CHANGES AND CUSTOM PLUGGING, FRACTIONATED TREATMENT, ALL LESIONS,                                                                                                                                                                                                                                         
G025100300QPER SESSION, MAXIMUM FIVE SESSIONS PER COURSE OF TREATMENT                                                                                                                                                                                                                                                           
G025200100PPET IMAGING, FULL AND PARTIAL-RING PET SCANNERS ONLY, FOR INITIAL DIAGNOSIS OF  PET imaging initial dx      00      950-36                                                                                                M                          I2D 4       2002100120021001        N                           
G025200200QBREAST CANCER AND/OR SURGICAL PLANNING FOR BREAST CANCER (E.G. INITIAL STAGING                                                                                                                                                                                                                                       
G025200300QOF AXILLARY LYMPH NODES)                                                                                                                                                                                                                                                                                             
G025300100PPET IMAGING FOR BREAST CANCER, FULL AND PARTIAL-RING PET SCANNERS ONLY,         PET image brst dection recur11      A50-36                                                                                                C                          I2D 4       200210012005040120050331D                           
G025300200QSTAGING/RESTAGING OF LOCAL REGIONAL RECURRENCE OR DISTANT METASTASES (I.E.,                                                                                                                                                                                                                                          
G025300300QSTAGING/RESTAGING AFTER OR PRIOR TO COURSE OF TREATMENT)                                                                                                                                                                                                                                                             
G025400100PPET IMAGING FOR BREAST CANCER, FULL AND PARTIAL- RING PET SCANNERS ONLY,        PET image brst eval to tx   11      A50-36                                                                                                C                          I1C 4       200210012005040120050331D                           
G025400200QEVALUATION OF RESPONSE TO TREATMENT, PERFORMED DURING COURSE OF TREATMENT                                                                                                                                                                                                                                            
G025500100PCURRENT PERCEPTION THRESHOLD/SENSORY NERVE CONDUCTION TEST, (SNCT) PER LIMB,    Current percep threshold tst00      950-57                                                                                                M                          T2D 4       2002100120021001        N                           
G025500200QANY NERVE                                                                                                                                                                                                                                                                                                            
G025600100PPROSTATE BRACHYTHERAPY USING PERMANENTLY IMPLANTED PALLADIUM SEEDS, INCLUDING   Prostate brachy w palladium 00      9                                                                                                     D                      0107P1G 2       200301012004010120031231N                           
G025600200QTRANSPERITONEAL PLACEMENT OF NEEDLES OR CATHETERS INTO THE PROSTATE, CYSTOSCOPY                                                                                                                                                                                                                                      
G025600300QAND APPLICATION OF PERMANENT INTERSTITIAL RADIATION SOURCE                                                                                                                                                                                                                                                           
G025700100PUNSCHEDULED OR EMERGENCY DIALYSIS TREATMENT FOR AN ESRD PATIENT IN A HOSPITAL   Unsched dialysis ESRD pt hos00      9                                                                                                     D                      0107P6D 1       2003010120030101        N                           
G025700200QOUTPATIENT DEPARTMENT THAT IS NOT CERTIFIED AS AN ESRD FACILITY                                                                                                                                                                                                                                                      
G025800100PINTRAVENOUS INFUSION DURING SEPARATELY PAYABLE OBSERVATION STAY, PER            IV infusion during obs stay 00      9                                                                                                     D                      0107O1C 1       200204012006010120051231D                           
G025800200QOBSERVATION STAY (MUST BE REPORTED WITH G0244)                                                                                                                                                                                                                                                                       
G025900100PINJECTION PROCEDURE FOR SACROILIAC JOINT; ARTHROGRAPY                           Inject for sacroiliac joint 00      9                                                                                                     D                      0107O1E 1       2003010120030101        N                           
G026000100PINJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID      Inj for sacroiliac jt anesth00      9                                                                                                     D                      0107O1E F       2003010120041001        N                           
G026000200QAND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY                                                                                                                                                                                                                                                         
G026100100PPROSTATE BRACHYTHERAPY USING PERMANENTLY IMPLANTED IODINE SEEDS, INCLUDING      Prostate brachy w iodine see00      9                                                                                                     D                      0107P1G 2       200301012004010120031231N                           
G026100200QTRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO THE PROSTATE, CYSTOSCOPY                                                                                                                                                                                                                                        
G026100300QAND APPLICATION OF PERMANENT INTERSTITIAL RADIATION SOURCE                                                                                                                                                                                                                                                           
G026200100PSMALL INTESTINAL IMAGING; INTRALUMINAL, FROM LIGAMENT OF TREITZ TO THE ILEO     Sm intestinal image capsule 11      A                                                                                                     G                          I4B 4       200301012004010120031231N                           
G026200200QCECAL VALVE, INCLUDES PHYSICIAN INTERPRETATION AND REPORT                                                                                                                                                                                                                                                            
G026300100PDIRECT ADMISSION OF PATIENT WITH DIAGNOSIS OF CONGESTIVE HEART FAILURE, CHEST   Adm with CHF, CP, asthma    00      9                                                                                                     D                      0107M3  1       200301012006010120051231D                           
G026300200QPAIN OR ASTHMA FOR OBSERVATION SERVICES THAT MEET ALL CRITERIA FOR G0244                                                                                                                                                                                                                                             
G026400100PINITIAL NURSING ASSESSMENT OF PATIENT DIRECTLY ADMITTED TO OBSERVATION WITH     Assmt otr CHF, CP, asthma   00      9                                                                                                     D                      0107M3  1       200301012006010120051231D                           
G026400200QDIAGNOSIS OTHER THAN CHF, CHEST PAIN OR ASTHMA OR PATIENT DIRECTLY ADMITTED TO                                                                                                                                                                                                                                       
G026400300QOBSERVATION WITH DIAGNOSIS OF CHF, CHEST PAIN OR ASTHMA WHEN THE OBSERVATION                                                                                                                                                                                                                                         
G026400400QSTAY DOES NOT QUALIFY FOR G0244                                                                                                                                                                                                                                                                                      
G026500100PCRYOPRESERVATION, FREEZING AND STORAGE OF CELLS FOR THERAPEUTIC USE, EACH CELL  Cryopresevation Freeze+stora13      A                                                                                                     C                          T1H 5       2003010120030101        N                           
G026500200QLINE                                                                                                                                                                                                                                                                                                                 
G026600100PTHAWING AND EXPANSION OF FROZEN CELLS FOR THERAPEUTIC USE, EACH ALIQUOT         Thawing + expansion froz cel11      A                                                                                                     C                          T1H 5       2003010120030101        N                           
G026700100PBONE MARROW OR PERIPHERAL STEM CELL HARVEST, MODIFICATION OR TREATMENT TO       Bone marrow or psc harvest  11      A                                                                                                     C                          T1H 5       2003010120030101        N                           
G026700200QELIMINATE CELL TYPE(S) (E.G. T-CELLS, METASTATIC CARCINOMA)                                                                                                                                                                                                                                                          
G026800100PREMOVAL OF IMPACTED CERUMEN (ONE OR BOTH EARS) BY PHYSICIAN ON SAME DATE OF     Removal of impacted wax md  11      A                                                                                                     C                          P6C 2       2003010120030101        N                           
G026800200QSERVICE AS AUDIOLOGIC FUNCTION TESTING                                                                                                                                                                                                                                                                               
G026900100PPLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR ARTERIAL ACCESS SITE,     Occlusive device in vein art00      9                                                                                                     D                      0108P6D 1       2003010120030101        N                           
G026900200QPOST SURGICAL OR INTERVENTIONAL PROCEDURE (E.G. ANGIOSEAL PLUG, VASCULAR PLUG)                                                                                                                                                                                                                                       
G027000100PMEDICAL NUTRITION THERAPY; REASSESSMENT AND SUBSEQUENT INTERVENTION(S)          MNT subs tx for change dx   11      A                                                                                                     C                          M5D 1       2003010120030101        N                           
G027000200QFOLLOWING SECOND REFERRAL IN SAME YEAR FOR CHANGE IN DIAGNOSIS, MEDICAL                                                                                                                                                                                                                                              
G027000300QCONDITION OR TREATMENT REGIMEN (INCLUDING ADDITIONAL HOURS NEEDED FOR RENAL                                                                                                                                                                                                                                          
G027000400QDISEASE), INDIVIDUAL, FACE TO FACE WITH THE PATIENT, EACH 15 MINUTES                                                                                                                                                                                                                                                 
G027100100PMEDICAL NUTRITION THERAPY, REASSESSMENT AND SUBSEQUENT INTERVENTION(S)          Group MNT 2 or more 30 mins 11      A                                                                                                     C                          M5D 1       2003010120030101        N                           
G027100200QFOLLOWING SECOND REFERRAL IN SAME YEAR FOR CHANGE IN DIAGNOSIS, MEDICAL                                                                                                                                                                                                                                              
G027100300QCONDITION, OR TREATMENT REGIMEN (INCLUDING ADDITIONAL HOURS NEEDED FOR RENAL                                                                                                                                                                                                                                         
G027100400QDISEASE), GROUP (2 OR MORE INDIVIDUALS), EACH 30 MINUTES                                                                                                                                                                                                                                                             
G027200100PNASO/ORO GASTRIC TUBE PLACEMENT, REQUIRING PHYSICIAN'S SKILL AND FLUOROSCOPIC   Naso/oro gastric tube pl MD 11      A                                                                                                     G                          P6C 1       200301012004010120031231N                           
G027200200QGUIDANCE (INCLUDES FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT)                                                                                                                                                                                                                                                      
G027300100PRADIOPHARMACEUTICAL BIODISTRIBUTION, SINGLE OR MULTIPLE SCANS ON ONE OR MORE    Pretx planning, non-Hodgkins11      A                                                                                                     G                          I1E 6       200301012004010120031231N                           
G027300200QDAYS, PRE-TREATMENT PLANNING FOR RADIOPHARMACEUTICAL THERAPY OF NON-HODGKIN'S                                                                                                                                                                                                                                        
G027300300QLYMPHOMA, INCLUDES ADMINISTRATION OF RADIOPHARMACEUTICAL (E.G., RADIOLABELED                                                                                                                                                                                                                                         
G027300400QANTIBODIES)                                                                                                                                                                                                                                                                                                          
G027400100PRADIOPHARMACEUTICAL THERAPY, NON-HODGKIN'S LYMPHOMA, INCLUDES ADMINISTRATION OF Radiopharm tx, non-Hodgkins 11      A                                                                                                     G                          I1E 6       200301012004010120031231N                           
G027400200QRADIOPHARMACEUTICAL (.E.G. RADIOLABELED ANTIBODIES)                                                                                                                                                                                                                                                                  
G027500100PRENAL ARTERY ANGIOGRAPHY (UNILATERAL OR BILATERAL) PERFORMED AT THE TIME OF     Renal angio, cardiac cath   11      A                                                                                                     C                          I4A 2       2003010120030101        N                           
G027500200QCARDIAC CATHETERIZATION, INCLUDES CATHETER PLACEMENT, INJECTION OF DYE, FLUSH                                                                                                                                                                                                                                        
G027500300QAORTOGRAM AND RADIOLOGIC SUPERVISION AND INTERPRETATION AND PRODUCTION OF                                                                                                                                                                                                                                            
G027500400QIMAGES (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE)                                                                                                                                                                                                                                                            
G027800100PILIAC ARTERY ANGIOGRAPHY PERFORMED AT THE SAME TIME OF CARDIAC CATHETERIZATION, Iliac art angio,cardiac cath11      A                                                                                                     C                          I4A 2       2003010120030101        N                           
G027800200QINCLUDES CATHETER PLACEMENT, INJECTION OF DYE, RADIOLOGIC SUPERVISION AND                                                                                                                                                                                                                                            
G027800300QINTERPRETATION AND PRODUCTION OF IMAGES  (LIST SEPARATELY IN ADDITION TO                                                                                                                                                                                                                                             
G027800400QPRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                                   
G027900100PEXTRACORPOREAL SHOCK WAVE THERAPY; INVOLVING ELBOW EPICONDYLITIS                Excorp shock tx, elbow epi  11      A                                                                                                     C                          T2D 1UW     200301012006010120051231D                           
G028000100PEXTRACORPOREAL SHOCK WAVE THERAPY; INVOLVING OTHER THAN ELBOW EPICONDYLITIS OR  Excorp shock tx other than  11      A                                                                                                     C                          T2D 1UW     200301012006010120051231D                           
G028000200QPLANTAR FASCITIS                                                                                                                                                                                                                                                                                                     
G028100100PELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR CHRONIC STAGE   Elec stim unattend for press11      A                                                                                                     C                          P5E 1UW     2003040120030401        N                           
G028100200QIII AND STAGE IV PRESSURE ULCERS, ARTERIAL ULCERS, DIABETIC ULCERS, AND VENOUS                                                                                                                                                                                                                                       
G028100300QSTATSIS ULCERS NOT DEMONSTRATING MEASURABLE SIGNS OF HEALING AFTER 30 DAYS OF                                                                                                                                                                                                                                        
G028100400QCONVENTIONAL CARE, AS PART OF A THERAPY PLAN OF CARE                                                                                                                                                                                                                                                                 
G028200100PELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE      Elect stim wound care not pd00      9                  35-98                                                                              M                          P5E 1UW     2003040120030401        N                           
G028200200QOTHER THAN DESCRIBED IN G0281                                                                                                                                                                                                                                                                                        
G028300100PELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S)     Elec stim other than wound  11      A                                                                                                     C                          P5E 1UW     2003010120030101        N                           
G028300200QOTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE                                                                                                                                                                                                                                                             
G028800100PRECONSTRUCTION, COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF AORTA FOR SURGICAL PLANNING Recon, CTA for surg plan    11      A                                                                                                     C                          I2B 4       2003010120060101        T                           
G028800200QFOR VASCULAR SURGERY                                                                                                                                                                                                                                                                                                 
G028900100PARTHROSCOPY, KNEE, SURGICAL, FOR REMOVAL OF LOOSE BODY, FOREIGN BODY,           Arthro, loose body + chondro11      A                                                                                                     C                          P8A 2       2003010120030101        N                           
G028900200QDEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHRONDROPLASTY) AT THE TIME OF                                                                                                                                                                                                                                           
G028900300QOTHER SURGICAL KNEE ARTHROSCOPY IN A DIFFERENT COMPARTMENT OF THE SAME KNEE                                                                                                                                                                                                                                          
G029000100PTRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS, Drug-eluting stents, single 00      9                                                                                                     D                      0107P2D 2       2003010120030101        N                           
G029000200QWITH OR WITHOUT OTHER THERAPEUTIC INTERVENTION, ANY METHOD; SINGLE VESSEL                                                                                                                                                                                                                                            
G029100100PTRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS, Drug-eluting stents,each add00      9                                                                                                     D                      0107P2D 2       2003010120030101        N                           
G029100200QWITH OR WITHOUT OTHER THERAPEUTIC INTERVENTION, ANY METHOD; EACH ADDITIONAL                                                                                                                                                                                                                                          
G029100300QVESSEL                                                                                                                                                                                                                                                                                                               
G029200100PADMINISTRATION(S) OF EXPERIMENTAL DRUG(S) ONLY IN A MEDICARE QUALIFYING         Adm exp drugs,clinical trial00      9                                                                                                     D                      0109O1E 1       200301012005010120041231N                           
G029200200QCLINICAL TRIAL (INCLUDES ADMINISTRATION FOR CHEMOTHERAPY AND OTHER TYPES OF                                                                                                                                                                                                                                          
G029200300QTHERAPY VIA INFUSION AND/OR OTHER THAN INFUSION), PER DAY                                                                                                                                                                                                                                                            
G029300100PNONCOVERED SURGICAL PROCEDURE(S) USING CONSCIOUS SEDATION, REGIONAL, GENERAL OR Non-cov surg proc,clin trial00      9                                                                                                     D                      0107Y2  2       2003010120030101        N                           
G029300200QSPINAL ANESTHESIA IN A MEDICARE QUALIFYING CLINICAL TRIAL, PER DAY                                                                                                                                                                                                                                                   
G029400100PNONCOVERED PROCEDURE(S) USING EITHER NO ANESTHESIA OR LOCAL ANESTHESIA ONLY, IN Non-cov proc, clinical trial00      9                                                                                                     D                      0109Y2  2       2003010120030101        N                           
G029400200QA MEDICARE QUALIFYING CLINICAL TRIAL, PER DAY                                                                                                                                                                                                                                                                        
G029500100PELECTROMAGNETIC THERAPY, TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN        Electromagnetic therapy onc 00      935-98                                                                                                M                          I2B 1UW     2003040120040701        N                           
G029500200QDESCRIBED IN G0329 OR FOR OTHER USES                                                                                                                                                                                                                                                                                 
G029600100PPET IMAGING, FULL AND PARTIAL RING PET SCANNER ONLY, FOR RESTAGING OF           PET imge restag thyrod cance13      A                                                                                                     C                          I4B 4       200310012005040120050331D                           
G029600200QPREVIOUSLY TREATED THYROID CANCER OF FOLLICULAR CELL ORIGIN FOLLOWING NEGATIVE                                                                                                                                                                                                                                       
G029600300QI-131 WHOLE BODY SCAN                                                                                                                                                                                                                                                                                                
G029700100PINSERTION OF SINGLE CHAMBER PACING CARDIOVERTER DEFIBRILLATOR PULSE GENERATOR   Insert single chamber/cd    00      9                                                                                                     C                          P2B 2       2003100120031001        N                           
G029800100PINSERTION OF DUAL CHAMBER PACING CARDIOVERTER DEFIBRILLATOR PULSE GENERATOR     Insert dual chamber/cd      00      9                                                                                                     C                          P2B 2       2003100120031001        N                           
G029900100PINSERTION OR REPOSITIONING OF ELECTRODE LEAD FOR SINGLE CHAMBER PACING          Inser/repos single icd+leads00      9                                                                                                     C                          P2B 2       2003100120031001        N                           
G029900200QCARDIOVERTER DEFIBRILLATOR AND INSERTION OF PULSE GENERATOR                                                                                                                                                                                                                                                          
G030000100PINSERTION OR REPOSITIONING OF ELECTRODE LEAD(S) FOR DUAL CHAMBER PACING         Insert reposit lead dual+gen00      9                                                                                                     C                          P2B 2       2003100120031001        N                           
G030000200QCARDIOVERTER DEFIBRILLATOR AND INSERTION OF PULSE GENERATOR                                                                                                                                                                                                                                                          
G030200100PPRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, COMPLETE     Pre-op service LVRS complete00      9                                                                                                     C                          T2D 1       2004010120040101        N                           
G030200200QCOURSE OF SERVICES, TO INCLUDE A MINIMUM OF 16 DAYS OF SERVICES                                                                                                                                                                                                                                                      
G030300100PPRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, 10 TO 15     Pre-op service LVRS 10-15dos00      9                                                                                                     C                          T2D 1       2004010120040101        N                           
G030300200QDAYS OF SERVICES                                                                                                                                                                                                                                                                                                     
G030400100PPRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, 1 TO 9 DAYS  Pre-op service LVRS 1-9 dos 00      9                                                                                                     C                          T2D 1       2004010120040101        N                           
G030400200QOF SERVICES                                                                                                                                                                                                                                                                                                          
G030500100PPOST-DISCHARGE PULMONARY SURGERY SERVICES AFTER LVRS, MINIMUM OF 6 DAYS OF      Post op service LVRS min 6  00      9                                                                                                     C                          T2D 1       2004010120040101        N                           
G030500200QSERVICES                                                                                                                                                                                                                                                                                                             
G030600100PCOMPLETE CBC, AUTOMATED (HGB, HCT, RBC, WBC, WITHOUT PLATELET COUNT) AND        CBC/diffwbc w/o platelet    00      9                                                    400                                              C                          T1D 5       2004010120040101        N                           
G030600200QAUTOMATED WBC DIFFERENTIAL COUNT                                                                                                                                                                                                                                                                                     
G030700100PCOMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC; WITHOUT PLATELET COUNT)          CBC without platelet        00      9                                                    400                                              C                          T1D 5       2004010120040101        N                           
G030800100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svc 4+mo < 2yrs11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G030800200QFOR PATIENTS UNDER 2 YEARS OF AGE TO INCLUDE MONITORING FOR THE ADEQUACY OF                                                                                                                                                                                                                                          
G030800300QNUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF PARENTS;                                                                                                                                                                                                                                          
G030800400QWITH 4 OR MORE FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                               
G030900100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT  ESRD related svc 2-3mo <2yrs11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G030900200QFOR PATIENTS UNDER 2 YEARS OF AGE TO INCLUDE MONITORING FOR THE ADEQUACY OF                                                                                                                                                                                                                                          
G030900300QNUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF PARENTS;                                                                                                                                                                                                                                          
G030900400QWITH 2 OR 3 FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                                  
G031000100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svc 1 vst <2yrs11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031000200QFOR PATIENTS UNDER 2 YEARS OF AGE TO INCLUDE MONITORING FOR THE ADEQUACY OF                                                                                                                                                                                                                                          
G031000300QNUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF PARENTS;                                                                                                                                                                                                                                          
G031000400QWITH 1 FACE-TO-FACE PHYSICIAN VISIT PER MONTH                                                                                                                                                                                                                                                                        
G031100100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 4+mo 2-11yr11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031100200QFOR PATIENTS BETWEEN 2 AND 11 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                             
G031100300QADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G031100400QPARENTS; WITH 4 OR MORE FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                      
G031200100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD relate svs 2-3 mo 2-11y11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031200200QFOR PATIENTS BETWEEN 2 AND 11 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                             
G031200300QADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G031200400QPARENTS; WITH 2 OR 3 FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                         
G031300100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 1 mon 2-11y11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031300200QFOR PATIENTS BETWEEN 2 AND 11 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                             
G031300300QADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G031300400QPARENTS; WITH 1 FACE-TO-FACE PHYSICIAN VISIT PER MONTH                                                                                                                                                                                                                                                               
G031400100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES, DURING THE COURSE OF           ESRD related svs 4+ mo 12-1911      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031400200QTREATMENT, FOR PATIENTS BETWEEN 12 AND 19 YEARS OF AGE TO INCLUDE MONITORING                                                                                                                                                                                                                                         
G031400300QFOR THE ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND                                                                                                                                                                                                                                             
G031400400QCOUNSELING OF PARENTS; WITH 4 OR MORE FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                        
G031500100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 2-3mo/12-1911      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031500200QFOR PATIENTS BETWEEN 12 AND 19 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                            
G031500300QADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G031500400QPARENTS; WITH 2 OR 3 FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                         
G031600100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 1vis/12-19y11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031600200QFOR PATIENTS BETWEEN 12 AND 19 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                            
G031600300QADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G031600400QPARENTS; WITH 1 FACE-TO-FACE PHYSICIAN VISIT PER MONTH                                                                                                                                                                                                                                                               
G031700100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 4+mo 20+yrs11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031700200QFOR PATIENTS 20 YEARS OF AGE AND OVER; WITH 4 OR MORE FACE-TO-FACE PHYSICIAN                                                                                                                                                                                                                                         
G031700300QVISITS PER MONTH                                                                                                                                                                                                                                                                                                     
G031800100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 2-3 mo 20+y11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031800200QFOR PATIENTS 20 YEARS OF AGE AND OVER; WITH 2 OR 3 FACE-TO-FACE PHYSICIAN                                                                                                                                                                                                                                            
G031800300QVISITS PER MONTH                                                                                                                                                                                                                                                                                                     
G031900100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 1visit 20+y11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G031900200QFOR PATIENTS 20 YEARS OF AGE AND OVER; WITH 1 FACE-TO-FACE PHYSICIAN VISIT PER                                                                                                                                                                                                                                       
G031900300QMONTH                                                                                                                                                                                                                                                                                                                
G032000100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS PATIENTS PER  ESD related svs home undr 2 11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G032000200QFULL MONTH; FOR PATIENTS UNDER TWO YEARS OF AGE TO INCLUDE MONITORING FOR                                                                                                                                                                                                                                            
G032000300QADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G032000400QPARENTS                                                                                                                                                                                                                                                                                                              
G032100100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS PATIENTS PER  ESRDrelatedsvs home mo 2-11y11      A                  2230                                                                               D                          P9B M       2004010120040701        N                           
G032100200QFULL MONTH; FOR PATIENTS TWO TO ELEVEN YEARS OF AGE TO INCLUDE MONITORING FOR                                                                                                                                                                                                                                        
G032100300QADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G032100400QPARENTS                                                                                                                                                                                                                                                                                                              
G032200100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS PATIENTS PER  ESRD related svs hom mo12-1911      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G032200200QFULL MONTH; FOR PATIENTS TWELVE TO NINETEEN YEARS OF AGE TO INCLUDE MONITORING                                                                                                                                                                                                                                       
G032200300QFOR ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING                                                                                                                                                                                                                                      
G032200400QOF PARENTS                                                                                                                                                                                                                                                                                                           
G032300100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS PATIENTS PER  ESRD related svs home mo 20+11      A                  2230                                                                               D                          P9B M       2004010120041001        N                           
G032300200QFULL MONTH; FOR PATIENTS TWENTY YEARS OF AGE AND OLDER                                                                                                                                                                                                                                                               
G032400100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS (LESS THAN    ESRD relate svs home/dy <2yr11      A                  2230                                                                               D                          P9B 1       2004010120040101        N                           
G032400200QFULL MONTH), PER DAY; FOR PATIENTS UNDER TWO YEARS OF AGE                                                                                                                                                                                                                                                            
G032500100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS (LESS THAN    ESRD relate home/day/ 2-11yr11      A                  2230                                                                               D                          P9B 1       2004010120040101        N                           
G032500200QFULL MONTH), PER DAY; FOR PATIENTS BETWEEN TWO AND ELEVEN YEARS OF AGE                                                                                                                                                                                                                                               
G032600100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS (LESS THAN    ESRD relate home/dy 12-19yr 11      A                  2230                                                                               D                          P9B 1       2004010120040101        N                           
G032600200QFULL MONTH), PER DAY; FOR PATIENTS BETWEEN TWELVE AND NINETEEN YEARS OF AGE                                                                                                                                                                                                                                          
G032700100PEND STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS (LESS THAN    ESRD relate home/dy 20+yrs  11      A                  2230                                                                               D                          P9B 1       2004010120040101        N                           
G032700200QFULL MONTH), PER DAY; FOR PATIENTS TWENTY YEARS OF AGE AND OVER                                                                                                                                                                                                                                                      
G032800100PCOLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3          Fecal blood scrn immunoassay21      A                                                    310400                                           D                      0064T1H 1       2004010120040101        N                           
G032800200QSIMULTANEOUS                                                                                                                                                                                                                                                                                                         
G032900100PELECTROMAGNETIC THERAPY, TO ONE OR MORE AREAS FOR CHRONIC STAGE III AND STAGE   Electromagntic tx for ulcers00      9                                                                                                     C                          I2B 1UW     2004070120040701        N                           
G032900200QIV PRESSURE ULCERS, ARTERIAL ULCERS, DIABETIC ULCERS AND VENOUS STASIS ULCERS                                                                                                                                                                                                                                        
G032900300QNOT DEMONSTRATING MEASURABLE SIGNS OF HEALING AFTER 30 DAYS OF CONVENTIONAL                                                                                                                                                                                                                                          
G032900400QCARE AS PART OF A THERAPY PLAN OF CARE                                                                                                                                                                                                                                                                               
G033200100PSERVICES FOR INTRAVENOUS INFUSION OF IMMUNOGLOBULIN PRIOR TO ADMINISTRATION,    Preadmin IV immunoglobulin  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G033200200QPER INFUSION ENCOUNTER (THIS SERVICE IS TO BE BILLED IN CONJUNCTION WITH                                                                                                                                                                                                                                             
G033200300QADMINISTRATION OF IMMUNOGLOBULIN)                                                                                                                                                                                                                                                                                    
G033300100PPHARMACY DISPENSING FEE FOR INHALATION DRUG(S); INITIAL 30-DAY SUPPLY AS A      Dispense fee initial 30 day 46      A                                                                                                     D                      0121D1E 9       2006010120060101        A                           
G033300200QBENEFICIARY                                                                                                                                                                                                                                                                                                          
G033600100PPET IMAGING, BRAIN IMAGING FOR THE DIFFERENTIAL DIAGNOSIS OF ALZHEIMER'S        PET imaging brain alzheimers13      A35-82                                                                                                D                          I4B 4       200409152005040120050331D                           
G033600200QDISEASE WITH ABERRANT FEATURES VS FRONTO-TEMPORAL DEMENTIA                                                                                                                                                                                                                                                           
G033700100PHOSPICE EVALUATION AND COUNSELING SERVICES, PRE-ELECTION                        Hospice evaluation preelecti11      A                                                                                                     C                          M5D 1       2005010120050101        N                           
G033800100PLINEAR-ACCELERATOR-BASED STEREOTACTIC RADIOSURGERY PLAN, INCLUDING DOSE VOLUME  Linear accelerator stero pln00      9                                                                                                     C                          P5E 1       200401012006010120051231D                           
G033800200QHISTOGRAMS FOR TARGET AND CRITICAL STRUCTURE TOLERANCES, PLAN OPTIMIZATION                                                                                                                                                                                                                                           
G033800300QPERFORMED FOR HIGHLY CONFORMAL DISTRIBUTIONS, PLAN POSITIONAL ACCURACY AND DOSE                                                                                                                                                                                                                                      
G033800400QVERIFICATION, ALL LESIONS TREATED, PER COURSE OF TREATMENT                                                                                                                                                                                                                                                           
G033900100PIMAGE-GUIDED ROBOTIC LINEAR ACCELERATOR-BASED STEREOTACTIC RADIOSURGERY,        Robot lin-radsurg com, first00      9                                                                                                     C                          P5E 1       2004010120040101        N                           
G033900200QCOMPLETE COURSE OF THERAPY IN ONE SESSION OR FIRST SESSION OF FRACTIONATED                                                                                                                                                                                                                                           
G033900300QTREATMENT                                                                                                                                                                                                                                                                                                            
G034000100PIMAGE-GUIDED ROBOTIC LINEAR ACCELERATOR-BASED STEREOTACTIC RADIOSURGERY,        Robt lin-radsurg fractx 2-5 00      9                                                                                                     C                          P5E 1       2004010120040101        N                           
G034000200QDELIVERY INCLUDING COLLIMATOR CHANGES AND CUSTOM PLUGGING, FRACTIONATED                                                                                                                                                                                                                                              
G034000300QTREATMENT, ALL LESIONS, PER SESSION, SECOND THROUGH FIFTH SESSIONS, MAXIMUM                                                                                                                                                                                                                                          
G034000400QFIVE SESSIONS PER COURSE OF TREATMENT                                                                                                                                                                                                                                                                                
G034100100PPERCUTANEOUS ISLET CELL TRANSPLANT, INCLUDES PORTAL VEIN CATHETERIZATION AND    Percutaneous islet celltrans13      A260.3 35-82                                                                                          D                          P1G 2       2004100120041001        N                           
G034100200QINFUSION                                                                                                                                                                                                                                                                                                             
G034200100PLAPAROSCOPY FOR ISLET CELL TRANSPLANT, INCLUDES PORTAL VEIN CATHETERIZATION AND Laparoscopy islet cell trans13      A35-82                                                                                                D                          P1G 2       2004100120041001        N                           
G034200200QINFUSION                                                                                                                                                                                                                                                                                                             
G034300100PLAPAROTOMY FOR ISLET CELL TRANSPLANT, INCLUDES PORTAL VEIN CATHETERIZATION AND  Laparotomy islet cell transp13      A35-82                                                                                                D                          P1G 2       2004100120041001        N                           
G034300200QINFUSION                                                                                                                                                                                                                                                                                                             
G034400100PINITIAL PREVENTIVE PHYSICAL EXAMINATION; FACE-TO-FACE VISIT, SERVICES LIMITED   Initial preventive exam     11      A                                                                                                     C                          M1A 1       2005010120050101        N                           
G034400200QTO NEW BENEFICIARY DURING THE FIRST SIX MONTHS OF MEDICARE ENROLLMENT                                                                                                                                                                                                                                                
G034500100PINTRAVENOUS INFUSION, HYDRATION; INITIAL, UP TO ONE HOUR                        IV infuse hydration, initial11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G034600100PEACH ADDITIONAL HOUR, UP TO EIGHT (8) HOURS (LIST SEPARATELY IN ADDITION TO     Each additional infuse hour 11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G034600200QCODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                          
G034700100PINTRAVENOUS INFUSION, FOR THERAPEUTIC/DIAGNOSTIC (SPECIFY SUBSTANCE OR DRUG);   IV infusion therapy/diagnost11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G034700200QINITIAL, UP TO ONE HOUR                                                                                                                                                                                                                                                                                              
G034800100PEACH ADDITIONAL HOUR, UP TO EIGHT (8) HOURS (LIST SEPARATELY IN ADDITION TO     Each additional hr up to 8hr11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G034800200QCODE FOR PRIMARY PROCEDURE AND REPORT IN CONJUNCTION WITH G0347)                                                                                                                                                                                                                                                     
G034900100PADDITIONAL SEQUENTIAL INFUSION, UP TO ONE HOUR (LIST SEPARATELY IN ADDITION TO  Additional sequential infuse11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G034900200QCODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                          
G035000100PCONCURRENT INFUSION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Concurrent infusion         11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G035000200QREPORT ONLY ONCE PER SUBSTANCE/DRUG REGARDLESS OF DURATION, REPORT G0350 IN                                                                                                                                                                                                                                          
G035000300QCONJUNCTION WITH G0345                                                                                                                                                                                                                                                                                               
G035100100PTHERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS   Therapeutic/diagnostic injec11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G035100200QOR INTRAMUSCULAR                                                                                                                                                                                                                                                                                                     
G035300100PINTRAVENOUS PUSH, SINGLE OR INITIAL SUBSTANCE/DRUG                              IV push,single orinitial dru11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G035400100PEACH ADDITIONAL SEQUENTIAL INTRAVENOUS PUSH (LIST SEPARATELY IN ADDITION TO     Each addition sequential IV 11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G035400200QCODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                          
G035500100PCHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR NON-HORMONAL         Chemo adminisrate subcut/IM 11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G035500200QANTINEOPLASTIC                                                                                                                                                                                                                                                                                                       
G035600100PHORMONAL ANTI-NEOPLASTIC                                                        Hormonal anti-neoplastic    11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G035700100PINTRAVENOUS, PUSH TECHNIQUE, SINGLE OR INITIAL SUBSTANCE/DRUG                   IV push single/initial subst11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G035800100PINTRAVENOUS, PUSH TECHNIQUE, EACH ADDITIONAL SUBSTANCE/DRUG (LIST SEPARATELY IN IV push each additional drug11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G035800200QADDITION TO CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                              
G035900100PCHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; UP TO ONE HOUR,    Chemotherapy IV one hr initi11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G035900200QSINGLE OR INITIAL SUBSTANCE/DRUG                                                                                                                                                                                                                                                                                     
G036000100PEACH ADDITIONAL HOUR, ONE TO EIGHT (8) HOURS (LIST SEPARATELY IN ADDITION TO    Each additional hr 1-8 hrs  11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G036000200QCODE FOR PRIMARY PROCEDURE) USE G0360 IN CONJUNCTION WITH G0359                                                                                                                                                                                                                                                      
G036100100PINITIATION OF PROLONGED CHEMOTHERAPY INFUSION (MORE THAN EIGHT HOURS),          Prolong chemo infuse>8hrs pu11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G036100200QREQUIRING USE OF A PORTABLE OR IMPLANTABLE PUMP                                                                                                                                                                                                                                                                      
G036200100PEACH ADDITIONAL SEQUENTIAL INFUSION (DIFFERENT SUBSTANCE/DRUG), UP TO ONE HOUR  Each add sequential infusion11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G036200200Q(USE WITH G0359)                                                                                                                                                                                                                                                                                                     
G036300100PIRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS (DO NOT  Irrigate implanted venous de11      A                                                                                                     C                          P6C 1       200501012006010120051231D                           
G036300200QREPORT G0363 IF AN INJECTION OR INFUSION IS PROVIDED ON THE SAME DAY)                                                                                                                                                                                                                                                
G036400100PBONE MARROW ASPIRATION PERFORMED WITH BONE MARROW BIOPSY THROUGH THE SAME       Bone marrow aspirate &biopsy11      A                                                                                                     C                          P6C 2       2005010120050101        N                           
G036400200QINCISION ON THE SAME DATE OF SERVICE                                                                                                                                                                                                                                                                                 
G036500100PVESSEL MAPPING OF VESSELS FOR HEMODIALYSIS ACCESS (SERVICES FOR PREOPERATIVE    Vessel mapping hemo access  11      A                                                                                                     C                          P9A 5       2005010120050101        N                           
G036500200QVESSEL MAPPING PRIOR TO CREATION OF HEMODIALYSIS ACCESS USING AN AUTOGENOUS                                                                                                                                                                                                                                          
G036500300QHEMODIALYSIS CONDUIT, INCLUDING ARTERIAL INFLOW AND VENOUS OUTFLOW)                                                                                                                                                                                                                                                  
G036600100PELECTROCARDIOGRAM, ROUTINE ECG WITH 12 LEADS; PERFORMED AS A COMPONENT OF THE   EKG for initial prevent exam11      A                                                                                                     C                          T2C 5       2005010120050101        N                           
G036600200QINITIAL PREVENTIVE EXAMINATION WITH INTERPRETATION AND REPORT                                                                                                                                                                                                                                                        
G036700100PTRACING ONLY, WITHOUT INTERPRETATION AND REPORT, PERFORMED AS A COMPONENT OF    EKG tracing for initial prev11      A                                                                                                     C                          T2C 5       2005010120050101        N                           
G036700200QTHE INITIAL PREVENTIVE EXAMINATION                                                                                                                                                                                                                                                                                   
G036800100PINTERPRETATION AND REPORT ONLY, PERFORMED AS A COMPONENT OF THE INITIAL         EKG interpret & report preve11      A                                                                                                     C                          T2C 5       2005010120050101        N                           
G036800200QPREVENTIVE EXAMINATION                                                                                                                                                                                                                                                                                               
G036900100PPHARMACY SUPPLY FEE FOR INITIAL IMMUNOSUPPRESSIVE DRUG(S) FIRST MONTH FOLLOWING Pharm fee 1st month transpla46      A                                                                            Q0510                    D                      0121D1E 9       200501012006010120051231D                           
G036900200QTRANSPLANT                                                                                                                                                                                                                                                                                                           
G037000100PPHARMACY SUPPLY FEE FOR ORAL ANTI-CANCER, ORAL ANTI-EMETIC OR IMMUNOSUPPRESSIVE Pharmacy fee oral cancer etc46      A                                                                            Q0511Q0512               D                      0121D1E 9       200501012006010120051231D                           
G037000200QDRUG(S)                                                                                                                                                                                                                                                                                                              
G037100100PPHARMACY DISPENSING FEE FOR INHALATION DRUG(S); PER 30 DAYS                     Pharm dispense inhalation 3046      A                                                                            Q0513                    D                      0121D1E 9       200501012006010120051231D                           
G037200100PPHYSICIAN SERVICE REQUIRED TO ESTABLISH AND DOCUMENT THE NEED FOR A POWER       MD service required for PMD 13      A                                                                                                     D                      0128M5D 1       2005102520051025        A                           
G037200200QMOBILITY DEVICE                                                                                                                                                                                                                                                                                                      
G037400100PPHARMACY DISPENSING FEE FOR INHALATION DRUG(S); PER 90 DAYS                     Pharm dispense inhalation 9046      A                                                                            Q0514                    D                      0121D1E 9       200501012006010120051231D                           
G037500100PSMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN  Smoke/tobacco counselng 3-1013      A                                                                                                     C                          M6  1       2005032320050323        A                           
G037500200Q3 MINUTES UP TO 10 MINUTES                                                                                                                                                                                                                                                                                           
G037600100PSMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTENSIVE, GREATER THAN 10  Smoke/tobacco counseling >1013      A                                                                                                     C                          M6  1       2005032320050323        A                           
G037600200QMINUTES                                                                                                                                                                                                                                                                                                              
G037800100PHOSPITAL OBSERVATION SERVICE, PER HOUR                                          Hospital observation per hr 00      9                                                                                                     D                      0107M2A 1       2006010120060101        A                           
G037900100PDIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE                       Direct admit hospital observ00      9                                                                                                     D                      0107M2A 1       2006010120060101        A                           
G300100100PADMINISTRATION AND SUPPLY OF TOSITUMOMAB, 450 MG                                Admin + supply, tositumomab 13      A                                                                                                     C                          T2D 1       2003070120030701        N                           
G800600100PACUTE MYOCARDIAL INFARCTION: PATIENT DOCUMENTED TO HAVE RECEIVED ASPIRIN AT     AMI pt recd aspirin at arriv00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G800600200QARRIVAL                                                                                                                                                                                                                                                                                                              
G800700100PACUTE MYOCARDIAL INFARCTION: PATIENT NOT DOCUMENTED TO HAVE RECEIVED ASPIRIN AT AMI pt did not receiv aspiri00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G800700200QARRIVAL                                                                                                                                                                                                                                                                                                              
G800800100PCLINICIAN DOCUMENTED THAT ACUTE MYOCARDIAL INFARCTION PATIENT WAS NOT AN        AMI pt ineligible for aspiri00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G800800200QELIGIBLE CANDIDATE TO RECEIVE ASPIRIN AT ARRIVAL MEASURE                                                                                                                                                                                                                                                             
G800900100PACUTE MYOCARDIAL INFARCTION: PATIENT DOCUMENTED TO HAVE RECEIVED BETA-BLOCKER   AMI pt recd Bblock at arr   00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G800900200QAT ARRIVAL                                                                                                                                                                                                                                                                                                           
G801000100PACUTE MYOCARDIAL INFARCTION: PATIENT NOT DOCUMENTED TO HAVE RECEIVED            AMI pt did not rec bblock   00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801000200QBETA-BLOCKER AT ARRIVAL                                                                                                                                                                                                                                                                                              
G801100100PCLINICIAN DOCUMENTED THAT ACUTE MYOCARDIAL INFARCTION PATIENT WAS NOT AN        AMI pt inelig Bbloc at arriv00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801100200QELIGIBLE CANDIDATE FOR BETA-BLOCKER AT ARRIVAL MEASURE                                                                                                                                                                                                                                                               
G801200100PPNEUMONIA: PATIENT DOCUMENTED TO HAVE RECEIVED ANTIBIOTIC WITHIN 4 HOURS OF     Pneum pt recv antibiotic 4 h00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801200200QPRESENTATION                                                                                                                                                                                                                                                                                                         
G801300100PPNEUMONIA: PATIENT NOT DOCUMENTED TO HAVE RECEIVED ANTIBIOTIC WITHIN 4 HOURS OF Pneum pt w/o antibiotic 4 hr00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801300200QPRESENTATION                                                                                                                                                                                                                                                                                                         
G801400100PCLINICIAN DOCUMENTED THAT PNEUMONIA PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR   Pneum pt not elig antibiotic00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801400200QANTIBIOTIC WITHIN 4 HOURS OF PRESENTATION MEASURE                                                                                                                                                                                                                                                                    
G801500100PDIABETIC PATIENT WITH MOST RECENT HEMOGLOBIN A1C LEVEL (WITHIN THE LAST 6       Diabetic pt w/ HBA1c>9%     00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801500200QMONTHS) DOCUMENTED AS GREATER THAN 9%                                                                                                                                                                                                                                                                                
G801600100PDIABETIC PATIENT WITH MOST RECENT HEMOGLOBIN A1C LEVEL (WITHIN THE LAST 6       Diabetic pt w/ HBA1c<or=9%  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801600200QMONTHS) DOCUMENTED AS LESS THAN OR EQUAL TO 9%                                                                                                                                                                                                                                                                       
G801700100PCLINICIAN DOCUMENTED THAT DIABETIC PATIENT WAS NOT ELIGIBLE CANDIDATE FOR       DM pt inelig for HBA1c measu00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801700200QHEMOGLOBIN A1C MEASURE                                                                                                                                                                                                                                                                                               
G801800100PCLINICIAN HAS NOT PROVIDED CARE FOR THE DIABETIC PATIENT FOR THE REQUIRED TIME  Care not provided for HbA1c 00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801800200QFOR HEMOGLOBIN A1C MEASURE (6 MONTHS)                                                                                                                                                                                                                                                                                
G801900100PDIABETIC PATIENT WITH MOST RECENT LOW-DENSITY LIPOPROTEIN (WITHIN THE LAST 12   Diabetic pt w/LDL>= 100mg/dl00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G801900200QMONTHS) DOCUMENTED AS GREATER THAN OR EQUAL TO 100 MG/DL                                                                                                                                                                                                                                                             
G802000100PDIABETIC PATIENT WITH MOST RECENT LOW-DENSITY LIPOPROTEIN (WITHIN THE LAST 12   Diab pt w/LDL< 100mg/dl     00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802000200QMONTHS) DOCUMENTED AS LESS THAN 100 MG/DL                                                                                                                                                                                                                                                                            
G802100100PCLINICIAN DOCUMENTED THAT DIABETIC PATIENT WAS NOT ELIGIBLE CANDIDATE FOR       Diab pt inelig for LDL meas 00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802100200QLOW-DENSITY LIPOPROTEIN MEASURE                                                                                                                                                                                                                                                                                      
G802200100PCLINICIAN HAS NOT PROVIDED CARE FOR THE DIABETIC PATIENT FOR THE REQUIRED TIME  Care not provided for LDL   00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802200200QFOR LOW-DENSITY LIPOPROTEIN MEASURE (12 MONTHS)                                                                                                                                                                                                                                                                      
G802300100PDIABETIC PATIENT WITH MOST RECENT BLOOD PRESSURE (WITHIN THE LAST 6 MONTHS)     DM pt w BP>=140/80          00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802300200QDOCUMENTED AS EQUAL TO OR GREATER THAN 140 SYSTOLIC OR EQUAL TO OR GREATER THAN                                                                                                                                                                                                                                      
G802300300Q80 MMHG DIASTOLIC                                                                                                                                                                                                                                                                                                    
G802400100PDIABETIC PATIENT WITH MOST RECENT BLOOD PRESSURE (WITHIN THE LAST 6 MONTHS)     Diabetic pt wBP<140/80      00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802400200QDOCUMENTED AS LESS THAN 140 SYSTOLIC AND LESS THAN 80 DIASTOLIC                                                                                                                                                                                                                                                      
G802500100PCLINICIAN DOCUMENTED THAT THE DIABETIC PATIENT WAS NOT ELIGIBLE CANDIDATE FOR   Diabetic pt inelig for BP me00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802500200QBLOOD PRESSURE MEASURE                                                                                                                                                                                                                                                                                               
G802600100PCLINICIAN HAS NOT PROVIDED CARE FOR THE DIABETIC PATIENT FOR THE REQUIRED TIME  Diabet pt w no care re BP me00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802600200QFOR BLOOD PRESSURE MEASURE (WITHIN THE LAST 6 MONTHS)                                                                                                                                                                                                                                                                
G802700100PHEART FAILURE PATIENT WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION (LVSD)         HF p w/LVSD on ACE-I/ARB    00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802700200QDOCUMENTED TO BE ON EITHER ANGIOTENSIN-CONVERTING ENZYME INHIBITOR OR                                                                                                                                                                                                                                                
G802700300QANGIOTENSIN-RECEPTOR BLOCKER (ACE-I OR ARB) THERAPY                                                                                                                                                                                                                                                                  
G802800100PHEART FAILURE PATIENT WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION (LVSD) NOT     HF pt w/LVSD not on ACE-I/AR00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802800200QDOCUMENTED TO BE ON EITHER ANGIOTENSIN-CONVERTING ENZYME INHIBITOR OR                                                                                                                                                                                                                                                
G802800300QANGIOTENSIN-RECEPTOR BLOCKER (ACE-I OR ARB) THERAPY                                                                                                                                                                                                                                                                  
G802900100PCLINICIAN DOCUMENTED THAT HEART FAILURE PATIENT WAS NOT AN ELIGIBLE CANDIDATE   HF pt not elig for ACE-I/ARB00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G802900200QFOR EITHER ANGIOTENSIN-CONVERTING ENZYME INHIBITOR OR ANGIOTENSIN-RECEPTOR                                                                                                                                                                                                                                           
G802900300QBLOCKER (ACE-I OR ARB) THERAPY MEASURE                                                                                                                                                                                                                                                                               
G803000100PHEART FAILURE PATIENT WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION (LVSD)         HF pt w/LVSD on Bblocker    00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803000200QDOCUMENTED TO BE ON BETA-BLOCKER THERAPY                                                                                                                                                                                                                                                                             
G803100100PHEART FAILURE PATIENT WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION (LVSD) NOT     HF pt w/LVSD not on Bblocker00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803100200QDOCUMENTED TO BE ON BETA-BLOCKER THERAPY                                                                                                                                                                                                                                                                             
G803200100PCLINICIAN DOCUMENTED THAT HEART FAILURE PATIENT WAS NOT ELIGIBLE CANDIDATE FOR  HF pt not elig for Bblocker 00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803200200QBETA-BLOCKER THERAPY MEASURE                                                                                                                                                                                                                                                                                         
G803300100PPRIOR MYOCARDIAL INFARCTION - CORONARY ARTERY DISEASE PATIENT DOCUMENTED TO BE  PMI-CAD pt on Bblocker      00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803300200QON BETA-BLOCKER THERAPY                                                                                                                                                                                                                                                                                              
G803400100PPRIOR MYOCARDIAL INFARCTION - CORONARY ARTERY DISEASE PATIENT NOT DOCUMENTED TO PMI-CAD pt not on Bblocker  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803400200QBE ON BETA-BLOCKER THERAPY                                                                                                                                                                                                                                                                                           
G803500100PCLINICIAN DOCUMENTED THAT PRIOR MYOCARDIAL INFARCTION - CORONARY ARTERY DISEASE PMI-CAD pt inelig Bblocker  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803500200QPATIENT WAS NOT ELIGIBLE CANDIDATE FOR BETA-BLOCKER THERAPY MEASURE                                                                                                                                                                                                                                                  
G803600100PCORONARY ARTERY DISEASE PATIENT DOCUMENTED TO BE ON ANTIPLATELET THERAPY        AMI-CAD pt doc on antiplatel00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803700100PCORONARY ARTERY DISEASE PATIENT NOT DOCUMENTED TO BE ON ANTIPLATELET THERAPY    AMI-CAD pt not docu on antip00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803800100PCLINICIAN DOCUMENTED THAT CORONARY ARTERY DISEASE PATIENT WAS NOT ELIGIBLE      AMI-CAD inelig antiplate mea00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803800200QCANDIDATE FOR ANTIPLATELET THERAPY MEASURE                                                                                                                                                                                                                                                                           
G803900100PCORONARY ARTERY DISEASE - PATIENT WITH LOW-DENSITY LIPOPROTEIN DOCUMENTED TO BE CAD pt w/LDL>100mg/dl       00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G803900200QGREATER THAN 100MG/DL                                                                                                                                                                                                                                                                                                
G804000100PCORONARY ARTERY DISEASE - PATIENT WITH LOW-DENSITY LIPOPROTEIN DOCUMENTED TO BE CAD pt w/LDL<or=100mg/dl    00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G804000200QLESS THAN OR EQUAL TO 100MG/DL                                                                                                                                                                                                                                                                                       
G804100100PCLINICIAN DOCUMENTED THAT CORONARY ARTERY DISEASE PATIENT WAS NOT ELIGIBLE      CAD pt not eligible for LDL 00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G804100200QCANDIDATE FOR LOW-DENSITY LIPOPROTEIN MEASURE                                                                                                                                                                                                                                                                        
G805100100PPATIENT (FEMALE) DOCUMENTED TO HAVE BEEN ASSESSED FOR OSTEOPOROSIS              Osteoporosis assess         00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G805200100PPATIENT (FEMALE) NOT DOCUMENTED TO HAVE BEEN ASSESSED FOR OSTEOPOROSIS          Osteopor pt not assess      00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G805300100PCLINICIAN DOCUMENTED THAT (FEMALE) PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR    Pt inelig for osteopor meas 00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G805300200QOSTEOPOROSIS ASSESSMENT MEASURE                                                                                                                                                                                                                                                                                      
G805400100PPATIENT NOT DOCUMENTED FOR THE ASSESSMENT FOR FALLS WITHIN LAST 12 MONTHS       Falls assess not docum 12 mo00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G805500100PPATIENT DOCUMENTED FOR THE ASSESSMENT FOR FALLS WITHIN LAST 12 MONTHS           Falls assess w/ 12 mon      00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G805600100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR THE FALLS   Not elig for falls assessmen00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G805600200QASSESSMENT MEASURE WITHIN THE LAST 12 MONTHS                                                                                                                                                                                                                                                                         
G805700100PPATIENT DOCUMENTED TO HAVE RECEIVED HEARING ASSESSMENT                          Hearing assess receive      00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G805800100PPATIENT NOT DOCUMENTED TO HAVE RECEIVED HEARING ASSESSMENT                      Pt w/o hearing assess       00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G805900100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR HEARING     Pt inelig for hearing assess00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G805900200QASSESSMENT MEASURE                                                                                                                                                                                                                                                                                                   
G806000100PPATIENT DOCUMENTED FOR THE ASSESSMENT OF URINARY INCONTINENCE                   Urinary incont pt assess    00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G806100100PPATIENT NOT DOCUMENTED FOR THE ASSESSMENT OF URINARY INCONTINENCE               Pt not assess for urinary in00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G806200100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR URINARY     Pt not elig for urinary inco00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G806200200QINCONTINENCE ASSESSMENT MEASURE                                                                                                                                                                                                                                                                                      
G807500100PEND STAGE RENAL DISEASE PATIENT WITH DOCUMENTED DIALYSIS DOSE OF URR GREATER    ESRD pt w/ dialy of URR>=65%00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G807500200QTHAN OR EQUAL TO 65% (OR KT/V GREATER THAN OR EQUAL TO 1.2)                                                                                                                                                                                                                                                          
G807600100PEND STAGE RENAL DISEASE PATIENT WITH DOCUMENTED DIALYSIS DOSE OF URR LESS THAN  ESRD pt w/ dialy of URR<65% 00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G807600200Q65% (OR KT/V LESS THAN 1.2)                                                                                                                                                                                                                                                                                          
G807700100PCLINICIAN DOCUMENTED THAT END STAGE RENAL DISEASE PATIENT WAS NOT AN ELIGIBLE   ESRD pt not elig for URR/KtV00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G807700200QCANDIDATE FOR URR OR KT/V MEASURE                                                                                                                                                                                                                                                                                    
G807800100PEND STAGE RENAL DISEASE PATIENT WITH DOCUMENTED HEMATOCRIT GREATER THAN OR      ESRD pt w/Hct>or=33         00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G807800200QEQUAL TO 33 (OR HEMOGLOBIN GREATER THAN OR EQUAL TO 11)                                                                                                                                                                                                                                                              
G807900100PEND STAGE RENAL DISEASE PATIENT WITH DOCUMENTED HEMATOCRIT LESS THAN 33 (OR     ESRD pt w/Hct<33            00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G807900200QHEMOGLOBIN LESS THAN 11)                                                                                                                                                                                                                                                                                             
G808000100PCLINICIAN DOCUMENTED THAT END STAGE RENAL DISEASE PATIENT WAS NOT AN ELIGIBLE   ESRD pt inelig for HCT/Hgb  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G808000200QCANDIDATE FOR HEMATOCRIT (HEMOGLOBIN) MEASURE                                                                                                                                                                                                                                                                        
G808100100PEND STAGE RENAL DISEASE PATIENT REQUIRING HEMODIALYSIS VASCULAR ACCESS          ESRD pt w/ auto AV fistula  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G808100200QDOCUMENTED TO HAVE RECEIVED AUTOGENOUS AV FISTULA                                                                                                                                                                                                                                                                    
G808200100PEND STAGE RENAL DISEASE PATIENT REQUIRING HEMODIALYSIS DOCUMENTED TO HAVE       ESRD pt w other fistula     00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G808200200QRECEIVED VASCULAR ACCESS OTHER THAN AUTOGENOUS AV FISTULA                                                                                                                                                                                                                                                            
G809300100PNEWLY DIAGNOSED CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENT DOCUMENTED COPD pt rec smoking cessat  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G809300200QTO HAVE RECEIVED SMOKING CESSATION INTERVENTION, WITHIN 3 MONTHS OF DIAGNOSIS                                                                                                                                                                                                                                        
G809400100PNEWLY DIAGNOSED CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENT NOT        COPD pt w/o smoke cessat int00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G809400200QDOCUMENTED TO HAVE RECEIVED SMOKING CESSATION INTERVENTION, WITHIN 3 MONTHS OF                                                                                                                                                                                                                                       
G809400300QDIAGNOSIS                                                                                                                                                                                                                                                                                                            
G809900100POSTEOPOROSIS PATIENT DOCUMENTED TO HAVE BEEN PRESCRIBED CALCIUM AND VITAMIN D   Osteopo pt given Ca+VitD sup00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G809900200QSUPPLEMENTS                                                                                                                                                                                                                                                                                                          
G810000100PCLINICIAN DOCUMENTED THAT OSTEOPOROSIS PATIENT WAS NOT AN ELIGIBLE CANDIDATE    Osteop pt inelig for Ca+VitD00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G810000200QFOR CALCIUM AND VITAMIN D SUPPLEMENT MEASURE                                                                                                                                                                                                                                                                         
G810300100PNEWLY DIAGNOSED OSTEOPOROSIS PATIENTS DOCUMENTED TO HAVE BEEN TREATED WITH      New dx osteo pt w/antiresorp00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G810300200QANTIRESORPTIVE THERAPY AND/OR PTH WITHIN 3 MONTHS OF DIAGNOSIS                                                                                                                                                                                                                                                       
G810400100PCLINICIAN DOCUMENTED THAT NEWLY DIAGNOSED OSTEOPOROSIS PATIENT WAS NOT AN       Osteo pt inelig for antireso00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G810400200QELIGIBLE CANDIDATE FOR ANTIRESORPTIVE THERAPY AND/OR PTH TREATMENT MEASURE                                                                                                                                                                                                                                           
G810400300QWITHIN 3 MONTHS OF DIAGNOSIS                                                                                                                                                                                                                                                                                         
G810600100PWITHIN 6 MONTHS OF SUFFERING A NONTRAUMATIC FRACTURE, FEMALE PATIENT 65 YEARS   Bone dens meas test perf    00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G810600200QOF AGE OR OLDER DOCUMENTED TO HAVE UNDERGONE BONE MINERAL DENSITY TESTING OR TO                                                                                                                                                                                                                                      
G810600300QHAVE BEEN PRESCRIBED A DRUG TO TREAT OR PREVENT OSTEOPOROSIS                                                                                                                                                                                                                                                         
G810700100PCLINICIAN DOCUMENTED THAT FEMALE PATIENT 65 YEARS OF AGE OR OLDER WHO SUFFERED  Bone dens meas test inelig  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G810700200QA NONTRAUMATIC FRACTURE WITHIN THE LAST 6 MONTHS WAS NOT AN ELIGIBLE CANDIDATE                                                                                                                                                                                                                                       
G810700300QFOR MEASURE TO TEST BONE MINERAL DENSITY OR DRUG TO TREAT OR PREVENT                                                                                                                                                                                                                                                 
G810700400QOSTEOPOROSIS                                                                                                                                                                                                                                                                                                         
G810800100PPATIENT DOCUMENTED TO HAVE RECEIVED INFLUENZA VACCINATION DURING INFLUENZA      Pt receiv influenza vacc    00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G810800200QSEASON                                                                                                                                                                                                                                                                                                               
G810900100PPATIENT NOT DOCUMENTED TO HAVE RECEIVED INFLUENZA VACCINATION DURING INFLUENZA  Pt w/o influenza vacc       00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G810900200QSEASON                                                                                                                                                                                                                                                                                                               
G811000100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR INFLUENZA   Pt inelig for influenza vacc00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G811000200QVACCINATION MEASURE                                                                                                                                                                                                                                                                                                  
G811100100PPATIENT (FEMALE) DOCUMENTED TO HAVE RECEIVED A MAMMOGRAM DURING THE MEASUREMENT Pt receiv mammogram         00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G811100200QYEAR OR PRIOR YEAR TO THE MEASUREMENT YEAR                                                                                                                                                                                                                                                                           
G811200100PPATIENT (FEMALE) NOT DOCUMENTED TO HAVE RECEIVED A MAMMOGRAM DURING THE         Pt not doc mammogram        00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G811200200QMEASUREMENT YEAR OR PRIOR YEAR TO THE MEASUREMENT YEAR                                                                                                                                                                                                                                                               
G811300100PCLINICIAN DOCUMENTED THAT FEMALE PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR      Pt ineligible mammography   00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G811300200QMAMMOGRAPHY MEASURE                                                                                                                                                                                                                                                                                                  
G811400100PCLINICIAN DID NOT PROVIDE CARE TO PATIENT FOR THE REQUIRED TIME OF MAMMOGRAPHY  Care not provided for mamogr00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G811400200QMEASURE (I.E., MEASUREMENT YEAR OR PRIOR YEAR)                                                                                                                                                                                                                                                                       
G811500100PPATIENT DOCUMENTED TO HAVE RECEIVED PNEUMOCOCCAL VACCINATION                    Pt receiv pneumo vacc       00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G811600100PPATIENT NOT DOCUMENTED TO HAVE RECEIVED PNEUMOCOCCAL VACCINATION                Pt did not rec pneumo vacc  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G811700100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR             Pt was inelig for pneumo vac00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G811700200QPNEUMOCOCCAL VACCINATION MEASURE                                                                                                                                                                                                                                                                                     
G812600100PPATIENT DOCUMENTED AS BEING TREATED WITH ANTIDEPRESSANT MEDICATION DURING THE   Pt treat w/antidepress12wks 00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G812600200QENTIRE 12 WEEK ACUTE TREATMENT PHASE                                                                                                                                                                                                                                                                                 
G812700100PPATIENT NOT DOCUMENTED AS BEING TREATED WITH ANTIDEPRESSANT MEDICATION DURING   Pt not treat w/antidepres12w00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G812700200QTHE ENTIRE 12 WEEKS ACUTE TREATMENT PHASE                                                                                                                                                                                                                                                                            
G812800100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR             Pt inelig for antidepres med00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G812800200QANTIDEPRESSANT MEDICATION DURING THE ENTIRE 12 WEEK ACUTE TREATMENT PHASE                                                                                                                                                                                                                                            
G812800300QMEASURE                                                                                                                                                                                                                                                                                                              
G812900100PPATIENT DOCUMENTED AS BEING TREATED WITH ANTIDEPRESSANT MEDICATION FOR AT LEAST Pt treat w/antidepres for 6m00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G812900200Q6 MONTHS CONTINUOUS TREATMENT PHASE                                                                                                                                                                                                                                                                                  
G813000100PPATIENT NOT DOCUMENTED AS BEING TREATED WITH ANTIDEPRESSANT MEDICATION FOR AT   Pt not treat w/antidepres 6m00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G813000200QLEAST 6 MONTHS CONTINUOUS TREATMENT PHASE                                                                                                                                                                                                                                                                            
G813100100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR             Pt inelig for antidepres med00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G813100200QANTIDEPRESSANT MEDICATION FOR CONTINUOUS TREATMENT PHASE                                                                                                                                                                                                                                                             
G815200100PPATIENT DOCUMENTED TO HAVE RECEIVED ANTIBIOTIC PROPHYLAXIS ONE HOUR PRIOR TO    Pt w/AB 1 hr prior to incisi00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G815200200QINCISION TIME (TWO HOURS FOR VANCOMYCIN)                                                                                                                                                                                                                                                                             
G815300100PPATIENT NOT DOCUMENTED TO HAVE RECEIVED ANTIBIOTIC PROPHYLAXIS ONE HOUR PRIOR   Pt not doc for AB 1 hr prior00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G815300200QTO INCISION TIME (TWO HOURS FOR VANCOMYCIN)                                                                                                                                                                                                                                                                          
G815400100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR ANTIBIOTIC  Pt ineligi for AB therapy   00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G815400200QPROPHYLAXIS ONE HOUR PRIOR TO INCISION TIME (TWO HOURS FOR VANCOMYCIN) MEASURE                                                                                                                                                                                                                                       
G815500100PPATIENT WITH DOCUMENTED RECEIPT OF THROMBOEMBOLISM PROPHYLAXIS                  Pt recd thromboemb prophylax00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G815600100PPATIENT WITHOUT DOCUMENTED RECEIPT OF THROMBOEMBOLISM PROPHYLAXIS               Pt did not rec thromboembo  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G815700100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR             Pt ineligi for thrombolism  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G815700200QTHROMBOEMBOLISM PROPHYLAXIS MEASURE                                                                                                                                                                                                                                                                                  
G815800100PPATIENT DOCUMENTED TO HAVE RECEIVED CORONARY ARTERY BYPASS GRAFT WITH USE OF    Pt recd CABG w/ IMA         00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G815800200QINTERNAL MAMMARY ARTERY                                                                                                                                                                                                                                                                                              
G815900100PPATIENT DOCUMENTED TO HAVE RECEIVED CORONARY ARTERY BYPASS GRAFT WITHOUT USE OF Pt w/CABG w/o IMA           00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G815900200QINTERNAL MAMMARY ARTERY                                                                                                                                                                                                                                                                                              
G816000100PCLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR CORONARY    Pt inelig for CABG w/IMA    00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G816000200QARTERY BYPASS GRAFT WITH USE OF INTERNAL MAMMARY ARTERY MEASURE                                                                                                                                                                                                                                                      
G816100100PPATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT DOCUMENTED TO HAVE RECEIVED  Iso CABG pt rec preop bblock00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G816100200QPRE-OPERATIVE BETA-BLOCKADE                                                                                                                                                                                                                                                                                          
G816200100PPATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT NOT DOCUMENTED TO HAVE       Iso CABG pt w/o preop Bblock00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G816200200QRECEIVED PRE-OPERATIVE BETA-BLOCKADE                                                                                                                                                                                                                                                                                 
G816300100PCLINICIAN DOCUMENTED THAT PATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT    Iso CABG pt inelig for preo 00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G816300200QWAS NOT AN ELIGIBLE CANDIDATE FOR PRE-OPERATIVE BETA-BLOCKADE MEASURE                                                                                                                                                                                                                                                
G816400100PPATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT DOCUMENTED TO HAVE PROLONGED Iso CABG pt w/prolng intub  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G816400200QINTUBATION                                                                                                                                                                                                                                                                                                           
G816500100PPATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT NOT DOCUMENTED TO HAVE       Iso CABG pt w/o prolng intub00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G816500200QPROLONGED INTUBATION                                                                                                                                                                                                                                                                                                 
G816600100PPATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT DOCUMENTED TO HAVE REQUIRED  Iso CABG req surg rexpo     00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G816600200QSURGICAL RE-EXPLORATION                                                                                                                                                                                                                                                                                              
G816700100PPATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT DID NOT REQUIRE SURGICAL     Iso CABG w/o surg explo     00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G816700200QRE-EXPLORATION                                                                                                                                                                                                                                                                                                       
G817000100PPATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT DOCUMENTED TO HAVE BEEN      CEA/ext bypass pt on aspirin00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G817000200QDISCHARGED ON ASPIRIN OR CLOPIDOGREL                                                                                                                                                                                                                                                                                 
G817100100PPATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT NOT DOCUMENTED TO HAVE BEEN  Pt w/carot endarct/ext bypas00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G817100200QDISCHARGED ON ASPIRIN OR CLOPIDOGREL                                                                                                                                                                                                                                                                                 
G817200100PCLINICIAN DOCUMENTED THAT PATIENT WITH ISOLATED CORONARY ARTERY BYPASS GRAFT    CEA/ext bypass pt not on asp00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G817200200QWAS NOT AN ELIGIBLE CANDIDATE FOR ANTIPLATELET THERAPY AT DISCHARGE MEASURE                                                                                                                                                                                                                                          
G818200100PCLINICIAN HAS NOT PROVIDED CARE FOR THE CARDIAC PATIENT FOR THE REQUIRED TIME   CAD pt care not prov LDL    00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G818200200QFOR LOW-DENSITY LIPOPROTEIN MEASURE (6 MONTHS)                                                                                                                                                                                                                                                                       
G818300100PPATIENT WITH HEART FAILURE AND ATRIAL FIBRILLATION DOCUMENTED TO BE ON WARFARIN HF/atrial fib pt on warfarin00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G818300200QTHERAPY                                                                                                                                                                                                                                                                                                              
G818400100PCLINICIAN DOCUMENTED THAT PATIENT WITH HEART FAILURE AND ATRIAL FIBRILLATION    HF/atrial fib pt inelig warf00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G818400200QWAS NOT AN ELIGIBLE CANDIDATE FOR WARFARIN THERAPY MEASURE                                                                                                                                                                                                                                                           
G818500100PPATIENTS DIAGNOSED WITH SYMPTOMATIC OSTEOARTHRITIS WITH DOCUMENTED ANNUAL       Osteoarth pt w/ assess pain 00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G818500200QASSESSMENT OF FUNCTION AND PAIN                                                                                                                                                                                                                                                                                      
G818600100PCLINICIAN DOCUMENTED THAT SYMPTOMATIC OSTEOARTHRITIS PATIENT WAS NOT AN         Osteoarth pt inelig assess  00      9                                                                                                     C                          M5D 1       2006010120060101        A                           
G818600200QELIGIBLE CANDIDATE FOR ANNUAL ASSESSMENT OF FUNCTION AND PAIN MEASURE                                                                                                                                                                                                                                                
G900100100PCOORDINATED CARE FEE, INITIAL RATE                                              MCCD, initial rate          00      9                                                                                                     D                      0097Y2  1       2000100120001001        N                           
G900200100PCOORDINATED CARE FEE, MAINTENANCE RATE                                          MCCD,maintenance rate       00      9                                                                                                     D                      0097Y2  1       2000100120001001        N                           
G900300100PCOORDINATED CARE FEE, RISK ADJUSTED HIGH, INITIAL                               MCCD, risk adj hi, initial  00      9                                                                                                     D                      0097Y2  1       2000100120001001        N                           
G900400100PCOORDINATED CARE FEE, RISK ADJUSTED LOW, INITIAL                                MCCD, risk adj lo, initial  00      9                                                                                                     D                      0097Y2  1       2000100120001001        N                           
G900500100PCOORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE                                 MCCD, risk adj, maintenance 00      9                                                                                                     D                      0097Y2  1       2000100120001001        N                           
G900600100PCOORDINATED CARE FEE, HOME MONITORING                                           MCCD, Home monitoring       00      9                                                                                                     D                      0097Y2  1       2000100120001001        N                           
G900700100PCOORDINATED CARE FEE, SCHEDULED TEAM CONFERENCE                                 MCCD, sch team conf         00      9                                                                                                     D                      0097Y2  1       2000100120001001        N                           
G900800100PCOORDINATED CARE FEE, PHYSICIAN COORDINATED CARE OVERSIGHT SERVICES             Mccd,phys coor-care ovrsght 00      9                                                                                                     D                      0097Y2  1       2000100120001001        N                           
G900900100PCOORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE, LEVEL 3                        MCCD, risk adj, level 3     00      9                                                                                                     D                      0096Y2  1       2001100120011001        N                           
G901000100PCOORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE, LEVEL 4                        MCCD, risk adj, level 4     00      9                                                                                                     D                      0096Y2  1       2001100120011001        N                           
G901100100PCOORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE, LEVEL 5                        MCCD, risk adj, level 5     00      9                                                                                                     D                      0096Y2  1       2001100120011001        N                           
G901200100POTHER SPECIFIED CASE MANAGEMENT SERVICE NOT ELSEWHERE CLASSIFIED                Other Specified Case Mgmt   00      9                                                                                                     D                      0096Y2  1       2001100120011001        N                           
G901300100PESRD DEMO BASIC BUNDLE LEVEL I                                                  ESRD demo bundle level I    00      9                                                                                                     M                      0096Y2  1       2004070120040701        N                           
G901400100PESRD DEMO EXPANDED BUNDLE INCLUDING VENOUS ACCESS AND RELATED SERVICES          ESRD demo bundle-level II   00      9                                                                                                     M                      0096Y2  1       2004070120040701        N                           
G901600100PSMOKING CESSATION COUNSELING, INDIVIDUAL, IN THE ABSENCE OF OR IN ADDITION TO   Demo-smoking cessation coun 00      9                                                                                                     M                      0096Y2  1       2001010120010101        N                           
G901600200QANY OTHER EVALUATION AND MANAGEMENT SERVICE, PER SESSION (6-10 MINUTES) [DEMO                                                                                                                                                                                                                                        
G901600300QPROJECT CODE ONLY]                                                                                                                                                                                                                                                                                                   
G901700100PAMANTADINE HYDROCHLORIDE, ORAL, PER 100 MG (FOR USE IN A MEDICARE-APPROVED      Amantadine HCL 100mg oral   13      A                                                                                                     C                          O1E 1       2004120120041201        N                           
G901700200QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G901800100PZANAMIVIR, INHALATION POWDER, ADMINISTERED THROUGH INHALER, PER 10 MG (FOR USE  Zanamivir,inhalation pwd 10m13      A                                                                                                     C                          O1E 1       2004120120041201        N                           
G901800200QIN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                        
G901900100POSELTAMIVIR PHOSPHATE, ORAL, PER 75 MG (FOR USE IN A MEDICARE-APPROVED          Oseltamivir phosphate 75mg  13      A                                                                                                     C                          O1E 1       2004120120041201        N                           
G901900200QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G902000100PRIMANTADINE HYDROCHLORIDE, ORAL, PER 100 MG (FOR USE IN A MEDICARE-APPROVED     Rimantadine HCL 100mg oral  13      A                                                                                                     C                          O1E 1       2004120120041201        N                           
G902000200QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G902100100PCHEMOTHERAPY ASSESSMENT FOR NAUSEA AND/OR VOMITING, PATIENT REPORTED, PERFORMED Chemo assess nausea vomit L113      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G902100200QAT THE TIME OF CHEMOTHERAPY ADMINISTRATION; ASSESSMENT LEVEL ONE: NOT AT ALL                                                                                                                                                                                                                                         
G902100300Q(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G902200100PCHEMOTHERAPY ASSESSMENT FOR NAUSEA AND/OR VOMITING, PATIENT REPORTED, PERFORMED Chemo assess nausea vomit L213      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G902200200QAT THE TIME OF CHEMOTHERAPY ADMINISTRATION; ASSESSMENT LEVEL TWO: A LITTLE (FOR                                                                                                                                                                                                                                      
G902200300QUSE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                    
G902300100PCHEMOTHERAPY ASSESSMENT FOR NAUSEA AND/OR VOMITING, PATIENT REPORTED, PERFORMED Chemo assess nausea vomit L313      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G902300200QAT THE TIME OF CHEMOTHERAPY ADMINISTRATION; ASSESSMENT LEVEL THREE: QUITE A BIT                                                                                                                                                                                                                                      
G902300300Q(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G902400100PCHEMOTHERAPY ASSESSMENT FOR NAUSEA AND/OR VOMITING, PATIENT REPORTED, PERFORMED Chemo assess nausea vomit L413      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G902400200QAT THE TIME OF CHEMOTHERAPY ADMINISTRATION; ASSESSMENT LEVEL FOUR: VERY MUCH                                                                                                                                                                                                                                         
G902400300Q(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G902500100PCHEMOTHERAPY ASSESSMENT FOR PAIN, PATIENT REPORTED, PERFORMED AT THE TIME OF    Chemo assessment pain level113      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G902500200QCHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL ONE: NOT AT ALL (FOR USE IN A                                                                                                                                                                                                                                          
G902500300QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G902600100PCHEMOTHERAPY ASSESSMENT FOR PAIN, PATIENT REPORTED, PERFORMED AT THE TIME OF    Chemo assessment pain level213      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G902600200QCHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL TWO: A LITTLE (FOR USE IN A                                                                                                                                                                                                                                            
G902600300QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G902700100PCHEMOTHERAPY ASSESSMENT FOR PAIN, PATIENT REPORTED, PERFORMED AT THE TIME OF    Chemo assessment pain level313      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G902700200QCHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL THREE: QUITE A BIT (FOR USE IN A                                                                                                                                                                                                                                       
G902700300QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G902800100PCHEMOTHERAPY ASSESSMENT FOR PAIN, PATIENT REPORTED, PERFORMED AT THE TIME OF    Chemo assessment pain level413      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G902800200QCHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL FOUR: VERY MUCH (FOR USE IN A                                                                                                                                                                                                                                          
G902800300QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G902900100PCHEMOTHERAPY ASSESSMENT FOR LACK OF ENERGY (FATIGUE), PATIENT REPORTED,         Chemo assess for fatigue L1 13      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G902900200QPERFORMED AT THE TIME OF CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL ONE: NOT                                                                                                                                                                                                                                      
G902900300QAT ALL (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                        
G903000100PCHEMOTHERAPY ASSESSMENT FOR LACK OF ENERGY (FATIGUE), PATIENT REPORTED,         Chemo assess for fatigue L2 13      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G903000200QPERFORMED AT THE TIME OF CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL TWO: A                                                                                                                                                                                                                                        
G903000300QLITTLE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                        
G903100100PCHEMOTHERAPY ASSESSMENT FOR LACK OF ENERGY (FATIGUE), PATIENT REPORTED,         Chemo assess for fatigue L3 13      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G903100200QPERFORMED AT THE TIME OF CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL THREE:                                                                                                                                                                                                                                        
G903100300QQUITE A BIT (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                   
G903200100PCHEMOTHERAPY ASSESSMENT FOR LACK OF ENERGY (FATIGUE), PATIENT REPORTED,         Chemo assess for fatigue L4 13      A                                                                                                     C                          P7B 1       200501012006010120051231D                           
G903200200QPERFORMED AT THE TIME OF CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL FOUR:                                                                                                                                                                                                                                         
G903200300QVERY MUCH (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                     
G903300100PAMANTADINE HYDROCHLORIDE, ORAL BRAND, PER 100 MG (FOR USE IN A                  Amantadine HCL oral brand   13      A                                                                                                     C                          O1E 1       2004120120041201        A                           
G903300200QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G903400100PZANAMIVIR, INHALATION POWDER, ADMINISTERED THROUGH INHALER, BRAND, PER 10 MG    Zanamivir, inh pwdr, brand  00      9                                                                                                     C                          O1E 1       2004120120041201        N                           
G903400200Q(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G903500100POSELTAMIVIR PHOSPHATE, ORAL, BRAND, PER 75 MG (FOR USE IN A MEDICARE-APPROVED   Oseltamivir phosp, brand    00      9                                                                                                     C                          O1E 1       2004120120041201        N                           
G903500200QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G903600100PRIMANTADINE HYDROCHLORIDE, ORAL, BRAND, PER 100 MG (FOR USE IN A                Rimantadine HCL, brand      00      9                                                                                                     C                          O1E 1       2004120120041201        N                           
G903600200QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G904100100PREHABILITATION SERVICES FOR LOW VISION BY QUALIFIED OCCUPATIONAL THERAPIST,     Low vision rehab occupationa00      9                                                                                                     C                          T2D 1       2006010120060101        A                           
G904100200QDIRECT ONE-ON-ONE CONTACT, EACH 15 MINUTES                                                                                                                                                                                                                                                                           
G904200100PREHABILITATION SERVICES FOR LOW VISION BY CERTIFIED ORIENTATION AND MOBILITY    Low vision rehab orient/mobi00      9                                                                                                     C                          T2D 1       2006010120060101        A                           
G904200200QSPECIALISTS, DIRECT ONE-ON-ONE CONTACT, EACH 15 MINUTES                                                                                                                                                                                                                                                              
G904300100PREHABILITATION SERVICES FOR LOW VISION BY CERTIFIED LOW VISION REHABILITATION   Low vision lowvision therapi00      9                                                                                                     C                          T2D 1       2006010120060101        A                           
G904300200QTHERAPIST, DIRECT ONE-ON-ONE CONTACT, EACH 15 MINUTES                                                                                                                                                                                                                                                                
G904400100PREHABILITATION SERVICES FOR LOW VISION BY CERTIFIED LOW VISION REHABILITATION   Low vision rehabilate teache00      9                                                                                                     C                          T2D 1       2006010120060101        A                           
G904400200QTEACHER, DIRECT ONE-ON-ONE CONTACT, EACH 15 MINUTES                                                                                                                                                                                                                                                                  
G905000100PONCOLOGY; PRIMARY FOCUS OF VISIT; WORK-UP, EVALUATION, OR STAGING AT THE TIME   Oncology work-up evaluation 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905000200QOF CANCER DIAGNOSIS OR RECURRENCE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION                                                                                                                                                                                                                                      
G905000300QPROJECT)                                                                                                                                                                                                                                                                                                             
G905100100PONCOLOGY; PRIMARY FOCUS OF VISIT; TREATMENT DECISION-MAKING AFTER DISEASE IS    Oncology treatment decision 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905100200QSTAGED OR RESTAGED, DISCUSSION OF TREATMENT OPTIONS, SUPERVISING/COORDINATING                                                                                                                                                                                                                                        
G905100300QACTIVE CANCER DIRECTED THERAPY OR MANAGING CONSEQUENCES OF CANCER DIRECTED                                                                                                                                                                                                                                           
G905100400QTHERAPY (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                       
G905200100PONCOLOGY; PRIMARY FOCUS OF VISIT; SURVEILLANCE FOR DISEASE RECURRENCE FOR       Onc surveillance for disease13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905200200QPATIENT WHO HAS COMPLETED DEFINITIVE CANCER-DIRECTED THERAPY AND CURRENTLY                                                                                                                                                                                                                                           
G905200300QLACKS EVIDENCE OF RECURRENT DISEASE; CANCER DIRECTED THERAPY MIGHT BE                                                                                                                                                                                                                                                
G905200400QCONSIDERED IN THE FUTURE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                      
G905300100PONCOLOGY; PRIMARY FOCUS OF VISIT; EXPECTANT MANAGEMENT OF PATIENT WITH EVIDENCE Onc expectant management pt 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905300200QOF CANCER FOR WHOM NO CANCER DIRECTED THERAPY IS BEING ADMINISTERED OR ARRANGED                                                                                                                                                                                                                                      
G905300300QAT PRESENT; CANCER DIRECTED THERAPY MIGHT BE CONSIDERED IN THE FUTURE (FOR USE                                                                                                                                                                                                                                       
G905300400QIN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                        
G905400100PONCOLOGY; PRIMARY FOCUS OF VISIT; SUPERVISING, COORDINATING OR MANAGING CARE OF Onc supervision palliative  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905400200QPATIENT WITH TERMINAL CANCER OR FOR WHOM OTHER MEDICAL ILLNESS PREVENTS FURTHER                                                                                                                                                                                                                                      
G905400300QCANCER TREATMENT; INCLUDES SYMPTOM MANAGEMENT, END-OF-LIFE CARE PLANNING,                                                                                                                                                                                                                                            
G905400400QMANAGEMENT OF PALLIATIVE THERAPIES (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                                   
G905400500QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G905500100PONCOLOGY; PRIMARY FOCUS OF VISIT; OTHER, UNSPECIFIED SERVICE NOT OTHERWISE      Onc visit unspecified NOS   13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905500200QLISTED (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                        
G905600100PONCOLOGY; PRACTICE GUIDELINES; MANAGEMENT ADHERES TO GUIDELINES (FOR USE IN A   Onc prac mgmt adheres guide 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905600200QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G905700100PONCOLOGY; PRACTICE GUIDELINES; MANAGEMENT DIFFERS FROM GUIDELINES AS A RESULT   Onc pract mgmt differs guide13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905700200QOF PATIENT ENROLLMENT IN AN INSTITUTIONAL REVIEW BOARD APPROVED CLINICAL TRIAL                                                                                                                                                                                                                                       
G905700300Q(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G905800100PONCOLOGY; PRACTICE GUIDELINES; MANAGEMENT DIFFERS FROM GUIDELINES BECAUSE THE   Onc prac mgmt disagree w/gui13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905800200QTREATING PHYSICIAN DISAGREES WITH GUIDELINE RECOMMENDATIONS (FOR USE IN A                                                                                                                                                                                                                                            
G905800300QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G905900100PONCOLOGY; PRACTICE GUIDELINES; MANAGEMENT DIFFERS FROM GUIDELINES BECAUSE THE   Onc prac mgmt pt opt alterna13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G905900200QPATIENT, AFTER BEING OFFERED TREATMENT CONSISTENT WITH GUIDELINES, HAS OPTED                                                                                                                                                                                                                                         
G905900300QFOR ALTERNATIVE TREATMENT OR MANAGEMENT, INCLUDING NO TREATMENT (FOR USE IN A                                                                                                                                                                                                                                        
G905900400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G906000100PONCOLOGY; PRACTICE GUIDELINES; MANAGEMENT DIFFERS FROM GUIDELINES FOR REASON(S) Onc prac mgmt dif pt comorb 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906000200QASSOCIATED WITH PATIENT COMORBID ILLNESS OR PERFORMANCE STATUS NOT FACTORED                                                                                                                                                                                                                                          
G906000300QINTO GUIDELINES (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                               
G906100100PONCOLOGY; PRACTICE GUIDELINES; PATIENT'S CONDITION NOT ADDRESSED BY AVAILABLE   Onc prac cond noadd by guide13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906100200QGUIDELINES (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                    
G906200100PONCOLOGY; PRACTICE GUIDELINES; MANAGEMENT DIFFERS FROM GUIDELINES FOR OTHER     Onc prac guide differs nos  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906200200QREASON(S) NOT LISTED (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                          
G906300100PONCOLOGY; DISEASE STATUS; LIMITED TO NON-SMALL CELL LUNG CANCER; EXTENT OF      Onc dx nsclc stgI no dx prog13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906300200QDISEASE INITIALLY ESTABLISHED AS STAGE I (PRIOR TO NEO-ADJUVANT THERAPY, IF                                                                                                                                                                                                                                          
G906300300QANY) WITH NO EVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR                                                                                                                                                                                                                                         
G906300400QUSE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                    
G906400100PONCOLOGY; DISEASE STATUS; LIMITED TO NON-SMALL CELL LUNG CANCER; EXTENT OF      Onc dx nsclc stg2 no dx prog13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906400200QDISEASE INITIALLY ESTABLISHED AS STAGE II (PRIOR TO NEO-ADJUVANT THERAPY, IF                                                                                                                                                                                                                                         
G906400300QANY) WITH NO EVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR                                                                                                                                                                                                                                         
G906400400QUSE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                    
G906500100PONCOLOGY; DISEASE STATUS; LIMITED TO NON-SMALL CELL LUNG CANCER; EXTENT OF      Onc dx nsclc stg3A nodx prog13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906500200QDISEASE INITIALLY ESTABLISHED AS STAGE III A (PRIOR TO NEO-ADJUVANT THERAPY, IF                                                                                                                                                                                                                                      
G906500300QANY) WITH NO EVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR                                                                                                                                                                                                                                         
G906500400QUSE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                    
G906600100PONCOLOGY; DISEASE STATUS; LIMITED TO NON-SMALL CELL LUNG CANCER; STAGE III B-   Onc dx nsclc stg3B-4 metasta13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906600200QIV AT DIAGNOSIS, METASTATIC, LOCALLY RECURRENT, OR PROGRESSIVE (FOR USE IN A                                                                                                                                                                                                                                         
G906600300QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G906700100PONCOLOGY; DISEASE STATUS; LIMITED TO NON-SMALL CELL LUNG CANCER; EXTENT OF      Onc dx nsclc dx unknown nos 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906700200QDISEASE UNKNOWN, UNDER EVALUATION, NOT YET DETERMINED, OR NOT LISTED (FOR USE                                                                                                                                                                                                                                        
G906700300QIN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                        
G906800100PONCOLOGY; DISEASE STATUS; LIMITED TO SMALL CELL AND COMBINED SMALL              Onc dx nsclc/sclc limited   13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906800200QCELL/NON-SMALL CELL; EXTENT OF DISEASE INITIALLY ESTABLISHED AS LIMITED WITH NO                                                                                                                                                                                                                                      
G906800300QEVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                             
G906800400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G906900100PONCOLOGY; DISEASE STATUS; SMALL CELL LUNG CANCER, LIMITED TO SMALL CELL AND     Onc dx sclc/nsclc ext at dx 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G906900200QCOMBINED SMALL CELL/NON-SMALL CELL; EXTENSIVE STAGE AT DIAGNOSIS, METASTATIC,                                                                                                                                                                                                                                        
G906900300QLOCALLY RECURRENT, OR PROGRESSIVE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION                                                                                                                                                                                                                                      
G906900400QPROJECT)                                                                                                                                                                                                                                                                                                             
G907000100PONCOLOGY; DISEASE STATUS; SMALL CELL LUNG CANCER, LIMITED TO SMALL CELL AND     Onc dx sclc/nsclc ext unknwn13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907000200QCOMBINED SMALL CELL/NON-SMALL; EXTENT OF DISEASE UNKNOWN, UNDER EVALUATION,                                                                                                                                                                                                                                          
G907000300QPRE-SURGICAL, OR NOT LISTED (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION                                                                                                                                                                                                                                            
G907000400QPROJECT)                                                                                                                                                                                                                                                                                                             
G907100100PONCOLOGY; DISEASE STATUS; INVASIVE FEMALE BREAST CANCER (DOES NOT INCLUDE       Onc dx brst stg1 2B no dx pr13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907100200QDUCTAL CARCINOMA IN SITU); ADENOCARCINOMA AS PREDOMINANT CELL TYPE; STAGE I OR                                                                                                                                                                                                                                       
G907100300QSTAGE IIA-IIB; OR T3, N1, M0; AND ER AND/OR PR POSITIVE; WITH NO EVIDENCE OF                                                                                                                                                                                                                                         
G907100400QDISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                       
G907100500QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G907200100PONCOLOGY; DISEASE STATUS; INVASIVE FEMALE BREAST CANCER (DOES NOT INCLUDE       Onc dx brst stg1-2 noprogres13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907200200QDUCTAL CARCINOMA IN SITU); ADENOCARCINOMA AS PREDOMINANT CELL TYPE; STAGE I, OR                                                                                                                                                                                                                                      
G907200300QSTAGE IIA-IIB; OR T3, N1, M0; AND ER AND PR NEGATIVE; WITH NO EVIDENCE OF                                                                                                                                                                                                                                            
G907200400QDISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                       
G907200500QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G907300100PONCOLOGY; DISEASE STATUS; INVASIVE FEMALE BREAST CANCER (DOES NOT INCLUDE       Onc dx brst stg3-w/progres  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907300200QDUCTAL CARCINOMA IN SITU); ADENOCARCINOMA AS PREDOMINANT CELL TYPE; STAGE                                                                                                                                                                                                                                            
G907300300QIIIA-IIIB; AND NOT T3, N1, M0; AND ER AND/OR PR POSITIVE; WITH NO EVIDENCE OF                                                                                                                                                                                                                                        
G907300400QDISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                       
G907300500QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G907400100PONCOLOGY; DISEASE STATUS; INVASIVE FEMALE BREAST CANCER (DOES NOT INCLUDE       Onc dx brst stg3-noprogress 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907400200QDUCTAL CARCINOMA IN SITU); ADENOCARCINOMA AS PREDOMINANT CELL TYPE; STAGE                                                                                                                                                                                                                                            
G907400300QIIIA-IIIB; AND NOT T3, N1, M0; AND ER AND PR NEGATIVE; WITH NO EVIDENCE OF                                                                                                                                                                                                                                           
G907400400QDISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                       
G907400500QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G907500100PONCOLOGY; DISEASE STATUS; INVASIVE FEMALE BREAST CANCER (DOES NOT INCLUDE       Onc dx brst metastic/ recur 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907500200QDUCTAL CARCINOMA IN SITU); ADENOCARCINOMA AS PREDOMINANT CELL TYPE; M1 AT                                                                                                                                                                                                                                            
G907500300QDIAGNOSIS, METASTATIC, LOCALLY RECURRENT, OR PROGRESSIVE (FOR USE IN A                                                                                                                                                                                                                                               
G907500400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G907600100PONCOLOGY; DISEASE STATUS; INVASIVE FEMALE BREAST CANCER (DOES NOT INCLUDE       Onc dx brst unknown NOS     13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907600200QDUCTAL CARCINOMA IN SITU); ADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF                                                                                                                                                                                                                                        
G907600300QDISEASE UNKNOWN, UNDER EVALUATION, PRE-SURGICAL OR NOT LISTED (FOR USE IN A                                                                                                                                                                                                                                          
G907600400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G907700100PONCOLOGY; DISEASE STATUS; PROSTATE CANCER, LIMITED TO ADENOCARCINOMA AS         Onc dx prostate T1no progres13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907700200QPREDOMINANT CELL TYPE; T1-T2C AND GLEASON 2-7 AND PSA < OR EQUAL TO 20 AT                                                                                                                                                                                                                                            
G907700300QDIAGNOSIS WITH NO EVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES                                                                                                                                                                                                                                         
G907700400Q(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G907800100PONCOLOGY; DISEASE STATUS; PROSTATE CANCER, LIMITED TO ADENOCARCINOMA AS         Onc dx prostate T2no progres13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907800200QPREDOMINANT CELL TYPE; T2 OR GLEASON 8-10 OR PSA > 20 AT DIAGNOSIS WITH NO                                                                                                                                                                                                                                           
G907800300QEVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                             
G907800400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G907900100PONCOLOGY; DISEASE STATUS; PROSTATE CANCER, LIMITED TO ADENOCARCINOMA AS         Onc dx prostate T3b-T4noprog13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G907900200QPREDOMINANT CELL TYPE; T3B-T4, ANY N; ANY T, N1 AT DIAGNOSIS WITH NO EVIDENCE                                                                                                                                                                                                                                        
G907900300QOF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                                      
G907900400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G908000100PONCOLOGY; DISEASE STATUS; PROSTATE CANCER, LIMITED TO ADENOCARCINOMA; AFTER     Onc dx prostate w/rise PSA  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908000200QINITIAL TREATMENT WITH RISING PSA OR FAILURE OF PSA DECLINE (FOR USE IN A                                                                                                                                                                                                                                            
G908000300QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G908100100PONCOLOGY; DISEASE STATUS; PROSTATE CANCER, LIMITED TO ADENOCARCINOMA;           Onc dx prostate mets no cast13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908100200QNON-CASTRATE, INCOMPLETELY CASTRATE; CLINICAL METASTASES OR M1 AT DIAGNOSIS                                                                                                                                                                                                                                          
G908100300Q(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G908200100PONCOLOGY; DISEASE STATUS; PROSTATE CANCER, LIMITED TO ADENOCARCINOMA; CASTRATE; Onc dx prostate castrate met13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908200200QCLINICAL METASTASES OR M1 AT DIAGNOSIS (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                               
G908200300QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G908300100PONCOLOGY; DISEASE STATUS; PROSTATE CANCER, LIMITED TO ADENOCARCINOMA; EXTENT OF Onc dx prostate unknown NOS 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908300200QDISEASE UNKNOWN, UNDER EVALUATION OR NOT LISTED (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                      
G908300300QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G908400100PONCOLOGY; DISEASE STATUS; COLON CANCER, LIMITED TO INVASIVE CANCER,             Onc dx colon t1-3,n1-2,no pr13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908400200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE INITIALLY                                                                                                                                                                                                                                                 
G908400300QESTABLISHED AS T1-3, N0, M0 WITH NO EVIDENCE OF DISEASE PROGRESSION,                                                                                                                                                                                                                                                 
G908400400QRECURRENCE, OR METASTASES (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                     
G908500100PONCOLOGY; DISEASE STATUS; COLON CANCER, LIMITED TO INVASIVE CANCER,             Onc dx colon T4, N0 w/o prog13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908500200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE INITIALLY                                                                                                                                                                                                                                                 
G908500300QESTABLISHED AS T4, N0, M0 WITH NO EVIDENCE OF DISEASE PROGRESSION, RECURRENCE,                                                                                                                                                                                                                                       
G908500400QOR METASTASES (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                 
G908600100PONCOLOGY; DISEASE STATUS; COLON CANCER, LIMITED TO INVASIVE CANCER,             Onc dx colon T1-4 no dx prog13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908600200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE INITIALLY                                                                                                                                                                                                                                                 
G908600300QESTABLISHED AS T1-4, N1-2, M0 WITH NO EVIDENCE OF DISEASE PROGRESSION,                                                                                                                                                                                                                                               
G908600400QRECURRENCE, OR METASTASES (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                     
G908700100PONCOLOGY; DISEASE STATUS; COLON CANCER, LIMITED TO INVASIVE CANCER,             Onc dx colon radiolg evid of13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908700200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; M1 AT DIAGNOSIS, METASTATIC, LOCALLY                                                                                                                                                                                                                                        
G908700300QRECURRENT, OR PROGRESSIVE WITH CURRENT CLINICAL, RADIOLOGIC, OR BIOCHEMICAL                                                                                                                                                                                                                                          
G908700400QEVIDENCE OF DISEASE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                           
G908800100PONCOLOGY; DISEASE STATUS; COLON CANCER, LIMITED TO INVASIVE CANCER,             Onc dx colon m1/mets w/o rad13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908800200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; M1 AT DIAGNOSIS, METASTATIC, LOCALLY                                                                                                                                                                                                                                        
G908800300QRECURRENT, OR PROGRESSIVE WITHOUT CURRENT CLINICAL, RADIOLOGIC, OR BIOCHEMICAL                                                                                                                                                                                                                                       
G908800400QEVIDENCE OF DISEASE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                           
G908900100PONCOLOGY; DISEASE STATUS; COLON CANCER, LIMITED TO INVASIVE CANCER,             Onc dx colon extent unknown 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G908900200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE UNKNOWN, NOT YET                                                                                                                                                                                                                                          
G908900300QDETERMINED, UNDER EVALUATION, PRE-SURGICAL, OR NOT LISTED (FOR USE IN A                                                                                                                                                                                                                                              
G908900400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                              
G909000100PONCOLOGY; DISEASE STATUS; RECTAL CANCER, LIMITED TO INVASIVE CANCER,            Onc dx rectal T1-2 no progr 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909000200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE INITIALLY                                                                                                                                                                                                                                                 
G909000300QESTABLISHED AS T1-2, N0, M0 (PRIOR TO NEO-ADJUVANT THERAPY, IF ANY) WITH NO                                                                                                                                                                                                                                          
G909000400QEVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                             
G909000500QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G909100100PONCOLOGY; DISEASE STATUS; RECTAL CANCER, LIMITED TO INVASIVE CANCER,            Onc dx rectal T3 N0 no prog 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909100200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE INITIALLY                                                                                                                                                                                                                                                 
G909100300QESTABLISHED AS T3, N0, M0 (PRIOR TO NEO-ADJUVANT THERAPY, IF ANY) WITH NO                                                                                                                                                                                                                                            
G909100400QEVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                             
G909100500QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G909200100PONCOLOGY; DISEASE STATUS; RECTAL CANCER, LIMITED TO INVASIVE CANCER,            Onc dx rectal T1-3,N1-2noprg13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909200200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE INITIALLY                                                                                                                                                                                                                                                 
G909200300QESTABLISHED AS T1-3, N1-2, M0 (PRIOR TO NEO-ADJUVANT THERAPY, IF ANY) WITH NO                                                                                                                                                                                                                                        
G909200400QEVIDENCE OF DISEASE PROGRESSION, RECURRENCE OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                              
G909200500QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G909300100PONCOLOGY; DISEASE STATUS; RECTAL CANCER, LIMITED TO INVASIVE CANCER,            Onc dx rectal T4,N,M0 no prg13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909300200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE INITIALLY                                                                                                                                                                                                                                                 
G909300300QESTABLISHED AS T4, ANY N, M0 (PRIOR TO NEO-ADJUVANT THERAPY, IF ANY) WITH NO                                                                                                                                                                                                                                         
G909300400QEVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                             
G909300500QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G909400100PONCOLOGY; DISEASE STATUS; RECTAL CANCER, LIMITED TO INVASIVE CANCER,            Onc dx rectal M1 w/mets prog13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909400200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; M1 AT DIAGNOSIS, METASTATIC, LOCALLY                                                                                                                                                                                                                                        
G909400300QRECURRENT, OR PROGRESSIVE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                     
G909500100PONCOLOGY; DISEASE STATUS; RECTAL CANCER, LIMITED TO INVASIVE CANCER,            Onc dx rectal extent unknwn 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909500200QADENOCARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE UNKNOWN, NOT YET                                                                                                                                                                                                                                          
G909500300QDETERMINED, UNDER EVALUATION, PRE-SURGICAL, OR NOT LISTED (FOR USE IN A                                                                                                                                                                                                                                              
G909500400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G909600100PONCOLOGY; DISEASE STATUS; ESOPHAGEAL CANCER, LIMITED TO ADENOCARCINOMA OR       Onc dx rectal ca t1-2,n0,m0 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909600200QSQUAMOUS CELL CARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE INITIALLY                                                                                                                                                                                                                                        
G909600300QESTABLISHED AS T1-T3, N0-N1 OR NX (PRIOR TO NEO-ADJUVANT THERAPY, IF ANY) WITH                                                                                                                                                                                                                                       
G909600400QNO EVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                          
G909600500QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G909700100PONCOLOGY; DISEASE STATUS; ESOPHAGEAL CANCER, LIMITED TO ADENOCARCINOMA OR       Onc dx rectal ca t3 n0 m0 t113      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909700200QSQUAMOUS  CELL CARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE INITIALLY                                                                                                                                                                                                                                       
G909700300QESTABLISHED AS T4, ANY N, M0 (PRIOR TO NEO-ADJUVANT THERAPY, IF ANY) WITH NO                                                                                                                                                                                                                                         
G909700400QEVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                             
G909700500QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G909800100PONCOLOGY; DISEASE STATUS; ESOPHAGEAL CANCER, LIMITED TO ADENOCARCINOMA OR       Onc dx rectal t4/local unres13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909800200QSQUAMOUS CELL CARCINOMA AS PREDOMINANT CELL TYPE; M1 AT DIAGNOSIS, METASTATIC,                                                                                                                                                                                                                                       
G909800300QLOCALLY RECURRENT, OR PROGRESSIVE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION                                                                                                                                                                                                                                      
G909800400QPROJECT)                                                                                                                                                                                                                                                                                                             
G909900100PONCOLOGY; DISEASE STATUS; ESOPHAGEAL CANCER, LIMITED TO ADENOCARCINOMA OR       Onc dx rectal m1/metalocal  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G909900200QSQUAMOUS CELL CARCINOMA AS PREDOMINANT CELL TYPE; EXTENT OF DISEASE UNKNOWN,                                                                                                                                                                                                                                         
G909900300QNOT YET DETERMINED, UNDER EVALUATION, PRE-SURGICAL, OR NOT LISTED (FOR USE IN A                                                                                                                                                                                                                                      
G909900400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G910000100PONCOLOGY; DISEASE STATUS; GASTRIC CANCER, LIMITED TO ADENOCARCINOMA AS          Onc dx gastric no recurrence13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910000200QPREDOMINANT CELL TYPE; POST R0 RESECTION (WITH OR WITHOUT NEOADJUVANT THERAPY)                                                                                                                                                                                                                                       
G910000300QWITH NO EVIDENCE OF DISEASE RECURRENCE, PROGRESSION, OR METASTASES (FOR USE IN                                                                                                                                                                                                                                       
G910000400QA MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                           
G910100100PONCOLOGY; DISEASE STATUS; GASTRIC CANCER, LIMITED TO ADENOCARCINOMA AS          Onc dx multi myeloma stage I13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910100200QPREDOMINANT CELL TYPE; POST R1 OR R2 RESECTION (WITH OR WITHOUT NEOADJUVANT                                                                                                                                                                                                                                          
G910100300QTHERAPY) WITH NO EVIDENCE OF DISEASE PROGRESSION, OR METASTASES (FOR USE IN A                                                                                                                                                                                                                                        
G910100400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G910200100PONCOLOGY; DISEASE STATUS; GASTRIC CANCER, LIMITED TO ADENOCARCINOMA AS          Onc dx multi myeloma stage2 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910200200QPREDOMINANT CELL TYPE; CLINICAL OR PATHOLOGIC M0, UNRESECTABLE WITH NO EVIDENCE                                                                                                                                                                                                                                      
G910200300QOF DISEASE PROGRESSION, OR METASTASES (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                                
G910200400QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G910300100PONCOLOGY; DISEASE STATUS; GASTRIC CANCER, LIMITED TO ADENOCARCINOMA AS          Onc dx multi myeloma unknown13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910300200QPREDOMINANT CELL TYPE; CLINICAL OR PATHOLOGIC M1 AT DIAGNOSIS, METASTATIC,                                                                                                                                                                                                                                           
G910300300QLOCALLY RECURRENT, OR PROGRESSIVE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION                                                                                                                                                                                                                                      
G910300400QPROJECT)                                                                                                                                                                                                                                                                                                             
G910400100PONCOLOGY; DISEASE STATUS; GASTRIC CANCER, LIMITED TO ADENOCARCINOMA AS          Onc dx CML initial treatment13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910400200QPREDOMINANT CELL TYPE; EXTENT OF DISEASE UNKNOWN, UNDER EVALUATION, NOT YET                                                                                                                                                                                                                                          
G910400300QDETERMINED, PRE-SURGICAL, OR NOT LISTED (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                              
G910400400QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G910500100PONCOLOGY; DISEASE STATUS; PANCREATIC CANCER, LIMITED TO ADENOCARCINOMA AS       Onc dx pancreatc p R0 res no13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910500200QPREDOMINANT CELL TYPE; POST R0 RESECTION WITHOUT EVIDENCE OF DISEASE                                                                                                                                                                                                                                                 
G910500300QPROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                               
G910500400QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G910600100PONCOLOGY; DISEASE STATUS; PANCREATIC CANCER, LIMITED TO ADENOCARCINOMA; POST R1 Onc dx pancreatc p R1/R2 no 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910600200QOR R2 RESECTION WITH NO EVIDENCE OF DISEASE PROGRESSION, OR METASTASES (FOR USE                                                                                                                                                                                                                                      
G910600300QIN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                        
G910700100PONCOLOGY; DISEASE STATUS; PANCREATIC CANCER, LIMITED TO ADENOCARCINOMA;         Onc dx pancreatic unresectab13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910700200QUNRESECTABLE AT DIAGNOSIS, M1 AT DIAGNOSIS, METASTATIC, LOCALLY RECURRENT, OR                                                                                                                                                                                                                                        
G910700300QPROGRESSIVE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                   
G910800100PONCOLOGY; DISEASE STATUS; PANCREATIC CANCER, LIMITED TO ADENOCARCINOMA; EXTENT  Onc dx pancreatic unknwn NOS13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910800200QOF DISEASE UNKNOWN, UNDER EVALUATION, NOT YET DETERMINED, PRE-SURGICAL, OR NOT                                                                                                                                                                                                                                       
G910800300QLISTED (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                        
G910900100PONCOLOGY; DISEASE STATUS; HEAD AND NECK CANCER, LIMITED TO CANCERS OF ORAL      Onc dx head/neck T1-T2no prg13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G910900200QCAVITY, PHARYNX AND LARYNX WITH SQUAMOUS CELL AS PREDOMINANT CELL TYPE; EXTENT                                                                                                                                                                                                                                       
G910900300QOF DISEASE INITIALLY ESTABLISHED AS T1-T2 AND N0, M0 (PRIOR TO NEO-ADJUVANT                                                                                                                                                                                                                                          
G910900400QTHERAPY, IF ANY) WITH NO EVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR                                                                                                                                                                                                                                             
G910900500QMETASTASES (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                    
G911000100PONCOLOGY; DISEASE STATUS; HEAD AND NECK CANCER, LIMITED TO CANCERS OF ORAL      Onc dx head/neck T3-4 noprog13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911000200QCAVITY, PHARYNX AND LARYNX WITH SQUAMOUS CELL AS PREDOMINANT CELL TYPE; EXTENT                                                                                                                                                                                                                                       
G911000300QOF DISEASE INITIALLY ESTABLISHED AS T3-4 AND/OR N1-3, M0 (PRIOR TO NEO-ADJUVANT                                                                                                                                                                                                                                      
G911000400QTHERAPY, IF ANY) WITH NO EVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR                                                                                                                                                                                                                                             
G911000500QMETASTASES (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                    
G911100100PONCOLOGY; DISEASE STATUS; HEAD AND NECK CANCER, LIMITED TO CANCERS OF ORAL      Onc dx head/neck M1 mets rec13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911100200QCAVITY, PHARYNX AND LARYNX WITH SQUAMOUS CELL AS PREDOMINANT CELL TYPE; M1 AT                                                                                                                                                                                                                                        
G911100300QDIAGNOSIS, METASTATIC, LOCALLY RECURRENT, OR PROGRESSIVE (FOR USE IN A                                                                                                                                                                                                                                               
G911100400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G911200100PONCOLOGY; DISEASE STATUS; HEAD AND NECK CANCER, LIMITED TO CANCERS OF ORAL      Onc dx head/neck ext unknown13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911200200QCAVITY, PHARYNX AND LARYNX WITH SQUAMOUS CELL AS PREDOMINANT CELL TYPE; EXTENT                                                                                                                                                                                                                                       
G911200300QOF DISEASE UNKNOWN, NOT YET DETERMINED, PRE-SURGICAL, OR NOT LISTED (FOR USE IN                                                                                                                                                                                                                                      
G911200400QA MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                           
G911300100PONCOLOGY; DISEASE STATUS; OVARIAN CANCER, LIMITED TO EPITHELIAL CANCER;         Onc dx ovarian stg1A-B no pr13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911300200QPATHOLOGIC STAGE IA-B (GRADE 1) WITHOUT EVIDENCE OF DISEASE PROGRESSION,                                                                                                                                                                                                                                             
G911300300QRECURRENCE, OR METASTASES (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                     
G911400100PONCOLOGY; DISEASE STATUS; OVARIAN CANCER, LIMITED TO EPITHELIAL CANCER;         Onc dx ovarian stg1A-B or 2 13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911400200QPATHOLOGIC STAGE IA-B (GRADE 2-3); OR STAGE IC (ALL GRADES); OR STAGE II;                                                                                                                                                                                                                                            
G911400300QWITHOUT EVIDENCE OF DISEASE PROGRESSION, RECURRENCE, OR METASTASES (FOR USE IN                                                                                                                                                                                                                                       
G911400400QA MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                           
G911500100PONCOLOGY; DISEASE STATUS; OVARIAN CANCER, LIMITED TO EPITHELIAL CANCER;         Onc dx ovarian stg3/4 noprog13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911500200QPATHOLOGIC STAGE III-IV; WITHOUT EVIDENCE OF PROGRESSION, RECURRENCE, OR                                                                                                                                                                                                                                             
G911500300QMETASTASES (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                    
G911600100PONCOLOGY; DISEASE STATUS; OVARIAN CANCER, LIMITED TO EPITHELIAL CANCER;         Onc dx ovarian recurrence   13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911600200QEVIDENCE OF DISEASE PROGRESSION, OR RECURRENCE, AND/OR PLATINUM RESISTANCE (FOR                                                                                                                                                                                                                                      
G911600300QUSE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                    
G911700100PONCOLOGY; DISEASE STATUS; OVARIAN CANCER, LIMITED TO EPITHELIAL CANCER; EXTENT  Onc dx ovarian unknown NOS  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911700200QOF DISEASE UNKNOWN, UNDER EVALUATION, INCOMPLETE SURGICAL STAGING, PRE-SURGICAL                                                                                                                                                                                                                                      
G911700300QSTAGING, OR NOT LISTED (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION  PROJECT)                                                                                                                                                                                                                                       
G911800100PONCOLOGY; DISEASE STATUS; NON-HODGKIN'S LYMPHOMA, LIMITED TO FOLLICULAR         Onc dx NHL stg 1-2 not relap13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911800200QLYMPHOMA, MANTLE CELL LYMPHOMA, DIFFUSE LARGE B-CELL LYMPHOMA, PERIPHERAL T                                                                                                                                                                                                                                          
G911800300QCELL LYMPHOMA; SMALL LYMPHOCYTIC LYMPHOMA; STAGE I, II AT DIAGNOSIS, NOT                                                                                                                                                                                                                                             
G911800400QRELAPSED, NOT REFRACTORY (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                      
G911900100PONCOLOGY; DISEASE STATUS; NON-HODGKIN'S LYMPHOMA, LIMITED TO FOLLICULAR         Onc dx NHL stg 3-4 not relap13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G911900200QLYMPHOMA, MANTLE CELL LYMPHOMA, DIFFUSE LARGE B-CELL LYMPHOMA, PERIPHERAL T                                                                                                                                                                                                                                          
G911900300QCELL LYMPHOMA, SMALL LYMPHOCYTIC LYMPHOMA; STAGE III, IV NOT RELAPSED, NOT                                                                                                                                                                                                                                           
G911900400QREFRACTORY (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                    
G912000100PONCOLOGY; DISEASE STATUS; NON-HODGKIN'S LYMPHOMA; LIMITED TO FOLLICULAR         Onc dx NHL trans to lg Bcell13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912000200QLYMPHOMA, DIFFUSE LARGE B-CELL LYMPHOMA; HISTOLOGICALLY TRANSFORMED FROM                                                                                                                                                                                                                                             
G912000300QFOLLICULAR LYMPHOMA TO DIFFUSE LARGE B-CELL LYMPHOMA (FOR USE IN A                                                                                                                                                                                                                                                   
G912000400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G912100100PONCOLOGY; DISEASE STATUS; NON-HODGKIN'S LYMPHOMA, LIMITED TO FOLLICULAR         Onc NHLstg 1-2 no relap no  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912100200QLYMPHOMA, MANTLE CELL LYMPHOMA, DIFFUSE LARGE B-CELL LYMPHOMA, PERIPHERAL T                                                                                                                                                                                                                                          
G912100300QCELL LYMPHOMA OR SMALL LYMPHOCYTIC LYMPHOMA; STAGE I, II AT DIAGNOSIS, NOT                                                                                                                                                                                                                                           
G912100400QRELAPSED AND NOT REFRACTORY, (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION                                                                                                                                                                                                                                           
G912100500QPROJECT)                                                                                                                                                                                                                                                                                                             
G912200100PONCOLOGY; DISEASE STATUS; NON-HODGKIN'S LYMPHOMA, LIMITED TO FOLLICULAR         Onc dx NHL stg 3/4no relap  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912200200QLYMPHOMA, MANTLE CELL LYMPHOMA, DIFFUSE LARGE B-CELL LYMPHOMA, PERIPHERAL T                                                                                                                                                                                                                                          
G912200300QCELL LYMPHOMA OR SMALL LYMPHOCYTIC LYMPHOMA; STAGE III, IV AT DIAGNOSIS, NOT                                                                                                                                                                                                                                         
G912200400QRELAPSED AND NOT REFRACTORY (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION                                                                                                                                                                                                                                            
G912200500QPROJECT)                                                                                                                                                                                                                                                                                                             
G912300100PONCOLOGY; DISEASE STATUS; NON-HODGKIN'S LYMPHOMA, LIMITED TO FOLLICULAR         Onc dx NHL lge Bcell relap  13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912300200QLYMPHOMA, MANTLE CELL LYMPHOMA, DIFFUSE LARGE B-CELL LYMPHOMA, OR                                                                                                                                                                                                                                                    
G912300300QHISTOLOGICALLY TRANSFORMED FROM FOLLICULAR LYMPHOMA TO DIFFUSE LARGE B-CELL                                                                                                                                                                                                                                          
G912300400QLYMPHOMA; RELAPSED OR REFRACTORY (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION                                                                                                                                                                                                                                       
G912300500QPROJECT)                                                                                                                                                                                                                                                                                                             
G912400100PONCOLOGY; DISEASE STATUS; NON-HODGKIN'S LYMPHOMA, LIMITED TO FOLLICULAR         Onc dx NHL relapse/refractor13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912400200QLYMPHOMA, MANTLE CELL LYMPHOMA, DIFFUSE LARGE B-CELL LYMPHOMA, PERIPHERAL T                                                                                                                                                                                                                                          
G912400300QCELL LYMPHOMA OR SMALL LYMPOCYTIC LYMPHOMA; RELAPSED AND REFRACTORY (FOR USE IN                                                                                                                                                                                                                                      
G912400400QA MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                           
G912500100PONCOLOGY; DISEASE STATUS; NON-HODGKIN'S LYMPHOMA, LIMITED TO FOLLICULAR         Onc dx NHL stg unknown      13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912500200QLYMPHOMA, MANTLE CELL LYMPHOMA, DIFFUSE LARGE B-CELL LYMPHOMA, PERIPHERAL T                                                                                                                                                                                                                                          
G912500300QCELL LYMPHOMA OR SMALL LYMPHOCYTIC LYMPHOMA; DIAGNOSTIC EVALUATION, STAGE NOT                                                                                                                                                                                                                                        
G912500400QDETERMINED, EVALUATION OF POSSIBLE RELAPSE OR NON-RESPONSE TO THERAPY, OR NOT                                                                                                                                                                                                                                        
G912500500QLISTED (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                        
G912600100PONCOLOGY; DISEASE STATUS; OVARIAN CANCER, LIMITED TO PATHOLOGICALLY STAGE       Onc dx ovarian stg IA/B     13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912600200QPATIENTS WITH EPITHELIAL CANCER; STAGE IA/IB (FOR USE IN A MEDICARE-APPROVED                                                                                                                                                                                                                                         
G912600300QDEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G912700100PONCOLOGY; DISEASE STATUS; LIMITED TO MULTIPLE MYELOMA, SYSTEMIC DISEASE;        Onc dx multi myeloma stage I13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912700200QSMOLDERING, STAGE I (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                           
G912800100PONCOLOGY; DISEASE STATUS; LIMITED TO MULTIPLE MYELOMA, SYSTEMIC DISEASE; STAGE  Onc dx mult myeloma stg2 hig13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912800200QII OR HIGHER (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                  
G912900100PONCOLOGY; DISEASE STATUS; CHRONIC MYELOGENOUS LEUKEMIA, LIMITED TO PHILADELPHIA Onc dx mult myeloma unkwn op13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G912900200QCHROMOSOME POSITIVE AND/OR BCR-ABL POSITIVE; EXTENT OF DISEASE UNKNOWN, UNDER                                                                                                                                                                                                                                        
G912900300QEVALUATION, NOT LISTED, OR TREATMENT OPTIONS BEING CONSIDERED (FOR USE IN A                                                                                                                                                                                                                                          
G912900400QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G913000100PONCOLOGY; DISEASE STATUS; LIMITED TO MULTIPLE MYELOMA, SYSTEMIC DISEASE; EXTENT Onc dx multi myeloma unknown13      A                                                                                                     C                          P7B 1       2006010120060101        A                           
G913000200QOF DISEASE UNKNOWN, UNDER EVALUATION, OR NOT LISTED (FOR USE IN A                                                                                                                                                                                                                                                    
G913000300QMEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
H000100100PALCOHOL AND/OR DRUG ASSESSMENT                                                  Alcohol and/or drug assess  00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H000200100PBEHAVIORAL HEALTH SCREENING TO DETERMINE ELIGIBILITY FOR ADMISSION TO TREATMENT Alcohol and/or drug screenin00      9                                                                                                     I                          Z2  9       2001010120030101        N                           
H000200200QPROGRAM                                                                                                                                                                                                                                                                                                              
H000300100PALCOHOL AND/OR DRUG SCREENING; LABORATORY ANALYSIS OF SPECIMENS FOR PRESENCE OF Alcohol and/or drug screenin00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H000300200QALCOHOL AND/OR DRUGS                                                                                                                                                                                                                                                                                                 
H000400100PBEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES                        Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120030101        N                           
H000500100PALCOHOL AND/OR DRUG SERVICES; GROUP COUNSELING BY A CLINICIAN                   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H000600100PALCOHOL AND/OR DRUG SERVICES; CASE MANAGEMENT                                   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H000700100PALCOHOL AND/OR DRUG SERVICES; CRISIS INTERVENTION (OUTPATIENT)                  Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H000800100PALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (HOSPITAL INPATIENT)     Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H000900100PALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (HOSPITAL INPATIENT)         Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H001000100PALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H001000200QPROGRAM INPATIENT)                                                                                                                                                                                                                                                                                                   
H001100100PALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION       Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H001100200QPROGRAM INPATIENT)                                                                                                                                                                                                                                                                                                   
H001200100PALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H001200200QPROGRAM OUTPATIENT)                                                                                                                                                                                                                                                                                                  
H001300100PALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION       Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H001300200QPROGRAM OUTPATIENT)                                                                                                                                                                                                                                                                                                  
H001400100PALCOHOL AND/OR DRUG SERVICES; AMBULATORY DETOXIFICATION                         Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H001500100PALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENT (TREATMENT PROGRAM THAT      Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H001500200QOPERATES AT LEAST 3 HOURS/DAY AND AT LEAST 3 DAYS/WEEK AND IS BASED ON AN                                                                                                                                                                                                                                            
H001500300QINDIVIDUALIZED TREATMENT PLAN), INCLUDING ASSESSMENT, COUNSELING; CRISIS                                                                                                                                                                                                                                             
H001500400QINTERVENTION, AND ACTIVITY THERAPIES OR EDUCATION                                                                                                                                                                                                                                                                    
H001600100PALCOHOL AND/OR DRUG SERVICES; MEDICAL/SOMATIC (MEDICAL INTERVENTION IN          Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H001600200QAMBULATORY SETTING)                                                                                                                                                                                                                                                                                                  
H001700100PBEHAVIORAL HEALTH; RESIDENTIAL (HOSPITAL RESIDENTIAL TREATMENT PROGRAM),        Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120030101        N                           
H001700200QWITHOUT ROOM AND BOARD, PER DIEM                                                                                                                                                                                                                                                                                     
H001800100PBEHAVIORAL HEALTH; SHORT-TERM RESIDENTIAL (NON-HOSPITAL RESIDENTIAL TREATMENT   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120030101        N                           
H001800200QPROGRAM), WITHOUT ROOM AND BOARD, PER DIEM                                                                                                                                                                                                                                                                           
H001900100PBEHAVIORAL HEALTH; LONG-TERM RESIDENTIAL (NON-MEDICAL, NON-ACUTE CARE IN A      Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120030101        N                           
H001900200QRESIDENTIAL TREATMENT PROGRAM WHERE STAY IS TYPICALLY LONGER THAN 30 DAYS),                                                                                                                                                                                                                                          
H001900300QWITHOUT ROOM AND BOARD, PER DIEM                                                                                                                                                                                                                                                                                     
H002000100PALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE           Alcohol and/or drug services00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H002000200Q(PROVISION OF THE DRUG BY A LICENSED PROGRAM)                                                                                                                                                                                                                                                                        
H002100100PALCOHOL AND/OR DRUG TRAINING SERVICE (FOR STAFF AND PERSONNEL NOT EMPLOYED BY   Alcohol and/or drug training00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H002100200QPROVIDERS)                                                                                                                                                                                                                                                                                                           
H002200100PALCOHOL AND/OR DRUG INTERVENTION SERVICE (PLANNED FACILITATION)                 Alcohol and/or drug interven00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H002300100PBEHAVIORAL HEALTH OUTREACH SERVICE (PLANNED APPROACH TO REACH A TARGETED        Alcohol and/or drug outreach00      9                                                                                                     I                          Z2  9       2001010120030101        N                           
H002300200QPOPULATION)                                                                                                                                                                                                                                                                                                          
H002400100PBEHAVIORAL HEALTH PREVENTION INFORMATION DISSEMINATION SERVICE (ONE-WAY DIRECT  Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9       2001010120030101        N                           
H002400200QOR NON-DIRECT CONTACT WITH SERVICE AUDIENCES TO AFFECT KNOWLEDGE AND ATTITUDE)                                                                                                                                                                                                                                       
H002500100PBEHAVIORAL HEALTH PREVENTION EDUCATION SERVICE (DELIVERY OF SERVICES WITH       Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9       2001010120030101        N                           
H002500200QTARGET POPULATION TO AFFECT KNOWLEDGE, ATTITUDE AND/OR BEHAVIOR)                                                                                                                                                                                                                                                     
H002600100PALCOHOL AND/OR DRUG PREVENTION PROCESS SERVICE, COMMUNITY-BASED (DELIVERY OF    Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H002600200QSERVICES TO DEVELOP SKILLS OF IMPACTORS)                                                                                                                                                                                                                                                                             
H002700100PALCOHOL AND/OR DRUG PREVENTION ENVIRONMENTAL SERVICE (BROAD RANGE OF EXTERNAL   Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H002700200QACTIVITIES GEARED TOWARD MODIFYING SYSTEMS IN ORDER TO MAINSTREAM PREVENTION                                                                                                                                                                                                                                         
H002700300QTHROUGH POLICY AND LAW)                                                                                                                                                                                                                                                                                              
H002800100PALCOHOL AND/OR DRUG PREVENTION PROBLEM IDENTIFICATION AND REFERRAL SERVICE      Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H002800200Q(E.G. STUDENT ASSISTANCE AND EMPLOYEE ASSISTANCE PROGRAMS), DOES NOT INCLUDE                                                                                                                                                                                                                                         
H002800300QASSESSMENT                                                                                                                                                                                                                                                                                                           
H002900100PALCOHOL AND/OR DRUG PREVENTION ALTERNATIVES SERVICE (SERVICES FOR POPULATIONS   Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9       2001010120010101        N                           
H002900200QTHAT EXCLUDE ALCOHOL AND OTHER DRUG USE E.G. ALCOHOL FREE SOCIAL EVENTS)                                                                                                                                                                                                                                             
H003000100PBEHAVIORAL HEALTH HOTLINE SERVICE                                               Alcohol and/or drug hotline 00      9                                                                                                     I                          Z2  9       2001010120030101        N                           
H003100100PMENTAL HEALTH ASSESSMENT, BY NON-PHYSICIAN                                      MH health assess by non-md  00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H003200100PMENTAL HEALTH SERVICE PLAN DEVELOPMENT BY NON-PHYSICIAN                         MH svc plan dev by non-md   00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H003300100PORAL MEDICATION ADMINISTRATION, DIRECT OBSERVATION                              Oral med adm direct observe 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H003400100PMEDICATION TRAINING AND SUPPORT, PER 15 MINUTES                                 Med trng & support per 15min00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H003500100PMENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS            MH partial hosp tx under 24h00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H003600100PCOMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT, FACE-TO-FACE, PER 15 MINUTES        Comm psy face-face per 15min00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H003700100PCOMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT PROGRAM, PER DIEM                    Comm psy sup tx pgm per diem00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H003800100PSELF-HELP/PEER SERVICES, PER 15 MINUTES                                         Self-help/peer svc per 15min00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H003900100PASSERTIVE COMMUNITY TREATMENT, FACE-TO-FACE, PER 15 MINUTES                     Asser com tx face-face/15min00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004000100PASSERTIVE COMMUNITY TREATMENT PROGRAM, PER DIEM                                 Assert comm tx pgm per diem 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004100100PFOSTER CARE, CHILD, NON-THERAPEUTIC, PER DIEM                                   Fos c chld non-ther per diem00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004200100PFOSTER CARE, CHILD, NON-THERAPEUTIC, PER MONTH                                  Fos c chld non-ther per mon 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004300100PSUPPORTED HOUSING, PER DIEM                                                     Supported housing, per diem 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004400100PSUPPORTED HOUSING, PER MONTH                                                    Supported housing, per month00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004500100PRESPITE CARE SERVICES, NOT IN THE HOME, PER DIEM                                Respite not-in-home per diem00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004600100PMENTAL HEALTH SERVICES, NOT OTHERWISE SPECIFIED                                 Mental health service, nos  00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004700100PALCOHOL AND/OR OTHER DRUG ABUSE SERVICES, NOT OTHERWISE SPECIFIED               Alcohol/drug abuse svc nos  00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004800100PALCOHOL AND/OR OTHER DRUG TESTING: COLLECTION AND HANDLING ONLY, SPECIMENS      Spec coll non-blood:a/d test00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H004800200QOTHER THAN BLOOD                                                                                                                                                                                                                                                                                                     
H100000100PPRENATAL CARE, AT-RISK ASSESSMENT                                               Prenatal care atrisk assessm00      9                                                                                                     I                          Z2  9       2002010120020101        N                           
H100100100PPRENATAL CARE, AT-RISK ENHANCED SERVICE; ANTEPARTUM MANAGEMENT                  Antepartum management       00      9                                                                                                     I                          Z2  9       2002010120020101        N                           
H100200100PPRENATAL CARE, AT RISK ENHANCED SERVICE; CARE COORDINATION                      Carecoordination prenatal   00      9                                                                                                     I                          Z2  9       2002010120020101        N                           
H100300100PPRENATAL CARE, AT-RISK ENHANCED SERVICE; EDUCATION                              Prenatal at risk education  00      9                                                                                                     I                          Z2  9       2002010120020101        N                           
H100400100PPRENATAL CARE, AT-RISK ENHANCED SERVICE; FOLLOW-UP HOME VISIT                   Follow up home visit/prental00      9                                                                                                     I                          Z2  9       2002010120020101        N                           
H100500100PPRENATAL CARE, AT-RISK ENHANCED SERVICE PACKAGE (INCLUDES H1001-H1004)          Prenatalcare enhanced srv pk00      9                                                                                                     I                          Z2  9       2002010120020101        N                           
H101000100PNON-MEDICAL FAMILY PLANNING EDUCATION, PER SESSION                              Nonmed family planning ed   00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H101100100PFAMILY ASSESSMENT BY LICENSED BEHAVIORAL HEALTH PROFESSIONAL FOR STATE DEFINED  Family assessment           00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H101100200QPURPOSES                                                                                                                                                                                                                                                                                                             
H200000100PCOMPREHENSIVE MULTIDISCIPLINARY EVALUATION                                      Comp multidisipln evaluation00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H200100100PREHABILITATION PROGRAM, PER 1/2 DAY                                             Rehabilitation program 1/2 d00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
H201000100PCOMPREHENSIVE MEDICATION SERVICES, PER 15 MINUTES                               Comprehensive med svc 15 min00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H201100100PCRISIS INTERVENTION SERVICE, PER 15 MINUTES                                     Crisis interven svc, 15 min 00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H201200100PBEHAVIORAL HEALTH DAY TREATMENT, PER HOUR                                       Behav hlth day treat, per hr00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H201300100PPSYCHIATRIC HEALTH FACILITY SERVICE, PER DIEM                                   Psych hlth fac svc, per diem00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H201400100PSKILLS TRAINING AND DEVELOPMENT, PER 15 MINUTES                                 Skills train and dev, 15 min00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H201500100PCOMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES                        Comp comm supp svc, 15 min  00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H201600100PCOMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER DIEM                              Comp comm supp svc, per diem00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H201700100PPSYCHOSOCIAL REHABILITATION SERVICES, PER 15 MINUTES                            Psysoc rehab svc, per 15 min00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H201800100PPSYCHOSOCIAL REHABILITATION SERVICES, PER DIEM                                  Psysoc rehab svc, per diem  00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H201900100PTHERAPEUTIC BEHAVIORAL SERVICES, PER 15 MINUTES                                 Ther behav svc, per 15 min  00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202000100PTHERAPEUTIC BEHAVIORAL SERVICES, PER DIEM                                       Ther behav svc, per diem    00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202100100PCOMMUNITY-BASED WRAP-AROUND SERVICES, PER 15 MINUTES                            Com wrap-around sv, 15 min  00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202200100PCOMMUNITY-BASED WRAP-AROUND SERVICES, PER DIEM                                  Com wrap-around sv, per diem00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202300100PSUPPORTED EMPLOYMENT, PER 15 MINUTES                                            Supported employ, per 15 min00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202400100PSUPPORTED EMPLOYMENT, PER DIEM                                                  Supported employ, per diem  00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202500100PONGOING SUPPORT TO MAINTAIN EMPLOYMENT, PER 15 MINUTES                          Supp maint employ, 15 min   00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202600100PONGOING SUPPORT TO MAINTAIN EMPLOYMENT, PER DIEM                                Supp maint employ, per diem 00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202700100PPSYCHOEDUCATIONAL SERVICE, PER 15 MINUTES                                       Psychoed svc, per 15 min    00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202800100PSEXUAL OFFENDER TREATMENT SERVICE, PER 15 MINUTES                               Sex offend tx svc, 15 min   00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H202900100PSEXUAL OFFENDER TREATMENT SERVICE, PER DIEM                                     Sex offend tx svc, per diem 00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H203000100PMENTAL HEALTH CLUBHOUSE SERVICES, PER 15 MINUTES                                MH clubhouse svc, per 15 min00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H203100100PMENTAL HEALTH CLUBHOUSE SERVICES, PER DIEM                                      MH clubhouse svc, per diem  00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H203200100PACTIVITY THERAPY, PER 15 MINUTES                                                Activity therapy, per 15 min00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H203300100PMULTISYSTEMIC THERAPY FOR JUVENILES, PER 15 MINUTES                             Multisys ther/juvenile 15min00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H203400100PALCOHOL AND/OR DRUG ABUSE HALFWAY HOUSE SERVICES, PER DIEM                      A/D halfway house, per diem 00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H203500100PALCOHOL AND/OR OTHER DRUG TREATMENT PROGRAM, PER HOUR                           A/D tx program, per hour    00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H203600100PALCOHOL AND/OR OTHER DRUG TREATMENT PROGRAM, PER DIEM                           A/D tx program, per diem    00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H203700100PDEVELOPMENTAL DELAY PREVENTION ACTIVITIES, DEPENDENT CHILD OF CLIENT, PER 15    Dev delay prev dp ch, 15 min00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
H203700200QMINUTES                                                                                                                                                                                                                                                                                                              
J012000100PINJECTION, TETRACYCLINE, UP TO 250 MG                                           Tetracyclin injection       51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J012800100PINJECTION, ABARELIX, 10 MG                                                      Abarelix injection          51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J013000100PINJECTION ABCIXIMAB, 10 MG                                                      Abciximab injection         51      A                  2049                                                                               D                          O1E 1P      1999010119990101        N                           
J013200100PINJECTION, ACETYLCYSTEINE, 100 MG                                               Acetylcysteine injection    51      A                                                                                                     C                          O1E 1P      2006010120060101        A                           
J013300100PINJECTION, ACYCLOVIR, 5 MG                                                      Acyclovir injection         51      A                                                                                                     C                          O1E 1P      2006010120060101        A                           
J013500100PINJECTION, ADALIMUMAB, 20 MG                                                    Adalimumab injection        51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J015000100PINJECTION, ADENOSINE FOR THERAPEUTIC USE,  6 MG (NOT TO BE USED TO REPORT ANY   Injection adenosine 6 MG    51      A                  2049                                                                               D                          O1E 1P      1994010120050101        N                           
J015000200QADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270)                                                                                                                                                                                                                                                                    
J015100100PINJECTION, ADENOSINE, 90 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE   Adenosine injection         51      A                  2049                                                      J0152                    D                          O1E 1P      199901012004010120031231N                           
J015100200QCOMPOUNDS, INSTEAD USE A9270)                                                                                                                                                                                                                                                                                        
J015200100PINJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY    Adenosine injection         51      A                                                                                                     C                          O1E 1P      2004010120050101        N                           
J015200200QADENOSINE PHOSPHATE COMPOUNDS; INSTEAD USE A9270)                                                                                                                                                                                                                                                                    
J017000100PINJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE                            Adrenalin epinephrin inject 51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J018000100PINJECTION, AGALSIDASE BETA, 1 MG                                                Agalsidase beta injection   51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J019000100PINJECTION, BIPERIDEN LACTATE, PER 5 MG                                          Inj biperiden lactate/5 mg  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J020000100PINJECTION, ALATROFLOXACIN MESYLATE, 100 MG                                      Alatrofloxacin mesylate     51      A                  2049.5                                                                             D                          O1E 1P      2000010120000101        N                           
J020500100PINJECTION, ALGLUCERASE, PER 10 UNITS                                            Alglucerase injection       51      A                  2049                                                                               D                          O1E 1P      1993010119970101        N                           
J020700100PINJECTION, AMIFOSTINE, 500 MG                                                   Amifostine                  51      A                  2049                                                                               D                          O1D 1P      1998010119980101        N                           
J021000100PINJECTION, METHYLDOPATE  HCL, UP TO 250 MG                                      Methyldopate hcl injection  51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J021500100PINJECTION, ALEFACEPT, 0.5 MG                                                    Alefacept                   51      A                                                                                                     C                          O1E 1G      2004010120040101        N                           
J025600100PINJECTION, ALPHA 1 - PROTEINASE INHIBITOR - HUMAN, 10 MG                        Alpha 1 proteinase inhibitor51      A                  2049                                                                               D                          O1E 1P      1989010119990101        N                           
J027000100PINJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE WHEN DRUG       Alprostadil for injection   51      A                  2049                                                                               D                          O1E 1       1997010120000101        N                           
J027000200QADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG                                                                                                                                                                                                                                      
J027000300QIS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                                
J027500100PALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRUG       Alprostadil urethral suppos 51      A                  2049                                                                               D                          O1E 1       1999010120000101        N                           
J027500200QADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG                                                                                                                                                                                                                                      
J027500300QIS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                                
J027800100PINJECTION, AMIKACIN SULFATE, 100 MG                                             Amikacin sulfate injection  51      A                                                                                                     C                          O1E 1P      2006010120060101        A                           
J028000100PINJECTION, AMINOPHYLLIN, UP TO 250 MG                                           Aminophyllin 250 MG inj     51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J028200100PINJECTION, AMIODARONE HYDROCHLORIDE, 30 MG                                      Amiodarone HCl              51      A                  2049                                                                               D                          O1E 1P      2001010120010101        N                           
J028500100PINJECTION, AMPHOTERICIN B, 50 MG                                                Amphotericin B              51      A                  2049                                                                               D                          O1E 1P      1999010119990101        N                           
J028600100PINJECTION, AMPHOTERICIN B, ANY LIPID FORMULATION, 50 MG                         Amphotericin B lipid complex51      A                  2049                                                                               D                          O1E 1P      199901012003010120021231N                           
J028700100PINJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG                                  Amphotericin b lipid complex51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J028800100PINJECTION, AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG                    Ampho b cholesteryl sulfate 51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J028900100PINJECTION, AMPHOTERICIN B LIPOSOME, 10 MG                                       Amphotericin b liposome inj 51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J029000100PINJECTION, AMPICILLIN SODIUM,  500 MG                                           Ampicillin 500 MG inj       51      A                  2049                                                                               D                          O1E 1P      1984010120000101        N                           
J029500100PINJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM                       Ampicillin sodium per 1.5 gm51      A                  2049                                                                               D                          O1E 1P      1995010119970101        N                           
J030000100PINJECTION, AMOBARBITAL, UP TO 125 MG                                            Amobarbital 125 MG inj      51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J033000100PINJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG                                Succinycholine chloride inj 51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J035000100PINJECTION, ANISTREPLASE, PER 30 UNITS                                           Injection anistreplase 30 u 51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J036000100PINJECTION, HYDRALAZINE HCL, UP TO 20 MG                                         Hydralazine hcl injection   51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J036500100PINJECTION, APROTONIN, 10,000 KIU                                                Aprotonin, 10,000 kiu       51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J038000100PINJECTION, METARAMINOL BITARTRATE, PER 10 MG                                    Inj metaraminol bitartrate  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J039000100PINJECTION, CHLOROQUINE HYDROCHLORIDE, UP TO 250 MG                              Chloroquine injection       51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J039500100PINJECTION, ARBUTAMINE HCL, 1 MG                                                 Arbutamine HCl injection    51      A                  2049                                                                               D                          O1E 1P      1999010119990101        N                           
J045600100PINJECTION, AZITHROMYCIN, 500 MG                                                 Azithromycin                51      A                  2049.5                                                                             D                          O1E 1P      2000010120000101        N                           
J046000100PINJECTION, ATROPINE SULFATE, UP TO 0.3 MG                                       Atropine sulfate injection  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J047000100PINJECTION, DIMERCAPROL, PER 100 MG                                              Dimecaprol injection        51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J047500100PINJECTION, BACLOFEN, 10 MG                                                      Baclofen 10 MG injection    51      A                  2049                                                                               D                          O1E 1P      1994010119970101        N                           
J047600100PINJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL                               Baclofen intrathecal trial  51      A                  2049                                                                               D                          O1E 1P      1999010119990101        N                           
J048000100PINJECTION, BASILIXIMAB, 20 MG                                                   Basiliximab                 51      A                  2049                                                                               D                      0095O1E 1G      2006010120060101        A                           
J050000100PINJECTION, DICYCLOMINE HCL, UP TO 20 MG                                         Dicyclomine injection       51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J051500100PINJECTION, BENZTROPINE MESYLATE, PER 1 MG                                       Inj benztropine mesylate    51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J052000100PINJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE, UP TO 5 MG          Bethanechol chloride inject 51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J053000100PINJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 600,000     Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J053000200QUNITS                                                                                                                                                                                                                                                                                                                
J054000100PINJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 1,200,000   Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J054000200QUNITS                                                                                                                                                                                                                                                                                                                
J055000100PINJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 2,400,000   Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J055000200QUNITS                                                                                                                                                                                                                                                                                                                
J056000100PINJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS                         Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J057000100PINJECTION, PENICILLIN G BENZATHINE, UP TO 1,200,000 UNITS                       Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J058000100PINJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000 UNITS                       Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J058300100PINJECTION, BIVALIRUDIN, 1 MG                                                    Bivalirudin                 51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J058500100PBOTULINUM TOXIN TYPE A, PER UNIT                                                Botulinum toxin a per unit  51      A                  2049                                                                               D                          O1E 1P      1991010119970101        N                           
J058700100PBOTULINUM TOXIN TYPE B, PER 100 UNITS                                           Botulinum toxin type B      51      A                  2049                                                                               D                          O1E 1P      2002010120020101        N                           
J059200100PINJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG                                  Buprenorphine hydrochloride 51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J059500100PINJECTION, BUTORPHANOL TARTRATE, 1 MG                                           Butorphanol tartrate 1 mg   51      A                                                                                                     C                          O1E 1       2004010120040101        N                           
J060000100PINJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG                              Edetate calcium disodium inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J061000100PINJECTION, CALCIUM GLUCONATE, PER 10 ML                                         Calcium gluconate injection 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J062000100PINJECTION, CALCIUM GLYCEROPHOSPHATE AND CALCIUM LACTATE, PER 10 ML              Calcium glycer & lact/10 ML 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J063000100PINJECTION, CALCITONIN SALMON, UP TO 400 UNITS                                   Calcitonin salmon injection 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J063500100PINJECTION, CALCITRIOL, 1 MCG AMP.                                               Calcitriol injection        51      A                  2049                                                                               D                          O1E 1P      199201012003010120021231N                           
J063600100PINJECTION, CALCITRIOL, 0.1 MCG                                                  Inj calcitriol per 0.1 mcg  51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J063700100PINJECTION, CASPOFUNGIN ACETATE, 5 MG                                            Caspofungin acetate         51      A                                                                                                     C                          O1E 1P      2003010120030101        N                           
J064000100PINJECTION, LEUCOVORIN CALCIUM, PER 50 MG                                        Leucovorin calcium injection51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J067000100PINJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML                                 Inj mepivacaine HCL/10 ml   51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J069000100PINJECTION, CEFAZOLIN SODIUM, 500 MG                                             Cefazolin sodium injection  51      A                  2049                                                                               D                          O1E 1P      1982010120000101        N                           
J069200100PINJECTION, CEFEPIME HYDROCHLORIDE, 500 MG                                       Cefepime HCl for injection  51      A                                                                                                     C                          O1E 1P      2002010120020101        N                           
J069400100PINJECTION, CEFOXITIN SODIUM, 1 GM                                               Cefoxitin sodium injection  51      A                  2049                                                      Q0090                    D                          O1E 1P      1992010119970101        N                           
J069600100PINJECTION, CEFTRIAXONE SODIUM, PER 250 MG                                       Ceftriaxone sodium injection51      A                  2049                                                                               D                          O1E 1P      1990010119970101        N                           
J069700100PINJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG                                Sterile cefuroxime injection51      A                  2049                                                                               D                          O1E 1P      1990010119970101        N                           
J069800100PINJECTION, CEFOTAXIME SODIUM, PER GM                                            Cefotaxime sodium injection 51      A                  2049                                                                               D                          O1E 1P      1991010119970101        N                           
J070200100PINJECTION, BETAMETHASONE ACETATE AND BETAMETHASONE SODIUM PHOSPHATE, PER 3 MG   Betamethasone acet&sod phosp51      A                  2049                                                                               D                          O1E 1P      1995010119970101        N                           
J070400100PINJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG                             Betamethasone sod phosp/4 MG51      A                  2049                                                                               D                          O1E 1P      1995010119970101        N                           
J070600100PINJECTION, CAFFEINE CITRATE, 5MG                                                Caffeine citrate injection  51      A                                                                                                     C                          O1E 1P      2002010120020101        N                           
J071000100PINJECTION, CEPHAPIRIN SODIUM, UP TO 1 GM                                        Cephapirin sodium injection 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J071300100PINJECTION, CEFTAZIDIME, PER 500 MG                                              Inj ceftazidime per 500 mg  51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J071500100PINJECTION, CEFTIZOXIME SODIUM, PER 500 MG                                       Ceftizoxime sodium / 500 MG 51      A                  2049                                                                               D                          O1E 1P      1995010119970101        N                           
J072000100PINJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 GM                         Chloramphenicol sodium injec51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J072500100PINJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS                          Chorionic gonadotropin/1000u51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J073500100PINJECTION, CLONIDINE HYDROCHLORIDE, 1 MG                                        Clonidine hydrochloride     51      A                  2049                                                                               D                          O1E 1P      1998010119980101        N                           
J074000100PINJECTION, CIDOFOVIR, 375 MG                                                    Cidofovir injection         51      A                  2049                                                                               D                          O1E 1P      1998010119980101        N                           
J074300100PINJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG                              Cilastatin sodium injection 51      A                  2049                                                                               D                          O1E 1P      1993010119970101        N                           
J074400100PINJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG                       Ciprofloxacin iv            51      A                                                                                                     C                          O1E 1P      2002010120020101        N                           
J074500100PINJECTION, CODEINE PHOSPHATE, PER 30 MG                                         Inj codeine phosphate /30 MG51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J076000100PINJECTION, COLCHICINE, PER 1MG                                                  Colchicine injection        51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J077000100PINJECTION, COLISTIMETHATE SODIUM, UP TO 150 MG                                  Colistimethate sodium inj   51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J078000100PINJECTION, PROCHLORPERAZINE, UP TO 10 MG                                        Prochlorperazine injection  51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J079500100PINJECTION, CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM                           Corticorelin ovine triflutal51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J080000100PINJECTION, CORTICOTROPIN, UP TO 40 UNITS                                        Corticotropin injection     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J083500100PINJECTION, COSYNTROPIN, PER 0.25 MG                                             Inj cosyntropin per 0.25 MG 51      A                  2049                                                                               D                          O1E 1P      1995010119970101        N                           
J085000100PINJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMAN), PER VIAL        Cytomegalovirus imm IV /vial51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J087800100PINJECTION, DAPTOMYCIN, 1 MG                                                     Daptomycin injection        51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J088000100PINJECTION, DARBEPOETIN ALFA, 5 MCG                                              Darbepoetin alfa injection  51      A                                                                                                     C                          O1E 1P      200301012006010120051231D                           
J088100100PINJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)                         Darbepoetin alfa, non-esrd  51      A                                                                                                     D                      0132O1E 1L      2006010120060101        A                           
J088200100PINJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS)                 Darbepoetin alfa, esrd use  57      A                  4273.1                                                                             D                          O1E 1L      2006010120060101        A                           
J088500100PINJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS                         Epoetin alfa, non-esrd      51      A                  2049                                                                               D                          O1E 9       2006010120060101        A                           
J088600100PINJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS)                      Epoetin alfa, esrd          57      A                  4273.1                                                                             D                          O1E 1L      2006010120060101        A                           
J089500100PINJECTION, DEFEROXAMINE MESYLATE, 500 MG                                        Deferoxamine mesylate inj   51      A                  2049                                                      Q0087                    D                          O1E 1P      1992010120010101        N                           
J090000100PINJECTION, TESTOSTERONE ENANTHATE AND ESTRADIOL VALERATE, UP TO 1 CC            Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J094500100PINJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG                                   Brompheniramine maleate inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J097000100PINJECTION, ESTRADIOL VALERATE, UP TO 40 MG                                      Estradiol valerate injection51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J100000100PINJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG                                 Depo-estradiol cypionate inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J102000100PINJECTION, METHYLPREDNISOLONE ACETATE, 20 MG                                    Methylprednisolone 20 MG inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J103000100PINJECTION, METHYLPREDNISOLONE ACETATE, 40 MG                                    Methylprednisolone 40 MG inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J104000100PINJECTION, METHYLPREDNISOLONE ACETATE, 80 MG                                    Methylprednisolone 80 MG inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J105000100PINJECTION, MEDROXYPROGESTERONE ACETATE, 100 MG                                  Medroxyprogesterone inj     51      A                  2049                                                                               D                          O1E 1P      198201012003010120021231N                           
J105100100PINJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG                                   Medroxyprogesterone inj     51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J105500100PINJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE, 150 MG            Medrxyprogester acetate inj 00      9                                          1862A1                                                     S                          O1E 1P      1994010119970101        N                           
J105600100PINJECTION, MEDROXYPROGESTERONE ACETATE / ESTRADIOL CYPIONATE, 5MG / 25MG        MA/EC contraceptiveinjection51      A                                                                                                     C                          O1E 1P      2002010120030101        N                           
J106000100PINJECTION, TESTOSTERONE CYPIONATE AND ESTRADIOL CYPIONATE, UP TO 1 ML           Testosterone cypionate 1 ML 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J107000100PINJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG                                 Testosterone cypionat 100 MG51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J108000100PINJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG                                 Testosterone cypionat 200 MG51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J109400100PINJECTION, DEXAMETHASONE ACETATE, 1 MG                                          Inj dexamethasone acetate   51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J109500100PINJECTION, DEXAMETHASONE ACETATE, PER 8 MG                                      Inj dexamethasone acetate   51      A                  2049                                                                               D                          O1E 1P      199601012003010120021231N                           
J110000100PINJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG                                  Dexamethasone sodium phos   51      A                  2049                                                                               D                          O1E 1P      1982010120010101        N                           
J111000100PINJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG                                 Inj dihydroergotamine mesylt51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J112000100PINJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG                                   Acetazolamid sodium injectio51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J116000100PINJECTION, DIGOXIN, UP TO 0.5 MG                                                Digoxin injection           51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J116200100PINJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL                                 Digoxin immune fab (ovine)  51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J116500100PINJECTION, PHENYTOIN SODIUM, PER 50 MG                                          Phenytoin sodium injection  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J117000100PINJECTION, HYDROMORPHONE, UP TO 4 MG                                            Hydromorphone injection     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J118000100PINJECTION, DYPHYLLINE, UP TO 500 MG                                             Dyphylline injection        51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J119000100PINJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG                                Dexrazoxane HCl injection   51      A                  2049                                                                               D                          O1E 1P      1997010119970101        N                           
J120000100PINJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG                                     Diphenhydramine hcl injectio51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J120500100PINJECTION, CHLOROTHIAZIDE SODIUM, PER 500 MG                                    Chlorothiazide sodium inj   51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J121200100PINJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML                                 Dimethyl sulfoxide 50% 50 ML51      A45-23             2049                                                                               D                          O1E 1P      1986010119970101        N                           
J123000100PINJECTION, METHADONE HCL, UP TO 10 MG                                           Methadone injection         51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J124000100PINJECTION, DIMENHYDRINATE, UP TO 50 MG                                          Dimenhydrinate injection    51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J124500100PINJECTION, DIPYRIDAMOLE, PER 10 MG                                              Dipyridamole injection      51      A                  15030   2049                                                                       D                          O1E 1P      1993010119980101        N                           
J125000100PINJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG                                 Inj dobutamine HCL/250 mg   51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J126000100PINJECTION, DOLASETRON MESYLATE, 10 MG                                           Dolasetron mesylate         51      A                  2049                                                                               D                          O1D 1P      1999010120000101        N                           
J126500100PINJECTION, DOPAMINE HCL, 40 MG                                                  Dopamine injection          51      A                                                                                                     C                          O1E 1P      2006010120060101        A                           
J127000100PINJECTION, DOXERCALCIFEROL, 1 MCG                                               Injection, doxercalciferol  51      A                                                                                                     C                          O1E 1P      2002010120020101        N                           
J132000100PINJECTION, AMITRIPTYLINE HCL, UP TO 20 MG                                       Amitriptyline injection     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J132500100PINJECTION, EPOPROSTENOL, 0.5 MG                                                 Epoprostenol injection      51      A                  2049                                                                               D                          O1E 1P      1998010119980101        N                           
J132700100PINJECTION, EPTIFIBATIDE, 5 MG                                                   Eptifibatide injection      51      A                  2049                                                                               D                          O1E 1P      2000010120000101        N                           
J133000100PINJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG                                     Ergonovine maleate injection51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J133500100PINJECTION, ERTAPENEM SODIUM, 500 MG                                             Ertapenem injection         51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J136400100PINJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG                                Erythro lactobionate /500 MG51      A                  2049                                                                               D                          O1E 1P      1995010119970101        N                           
J138000100PINJECTION, ESTRADIOL VALERATE, UP TO 10 MG                                      Estradiol valerate 10 MG inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J139000100PINJECTION, ESTRADIOL VALERATE, UP TO 20 MG                                      Estradiol valerate 20 MG inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J141000100PINJECTION, ESTROGEN  CONJUGATED, PER 25 MG                                      Inj estrogen conjugate 25 MG51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J143000100PINJECTION, ETHANOLAMINE OLEATE, 100 MG                                          Ethanolamine oleate 100 mg  51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J143500100PINJECTION, ESTRONE, PER 1 MG                                                    Injection estrone per 1 MG  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J143600100PINJECTION, ETIDRONATE DISODIUM, PER 300 MG                                      Etidronate disodium inj     51      A                  2049                                                                               D                          O1E 1P      1990010119970101        N                           
J143800100PINJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG           Etanercept injection        51      A                  2049                                                                               D                          O1E 1P      2000010120000101        N                           
J143800200QADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG                                                                                                                                                                                                                                      
J143800300QIS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                                
J144000100PINJECTION, FILGRASTIM (G-CSF), 300 MCG                                          Filgrastim 300 mcg injection51      A                  2049                                                                               D                          O1E 1P      1994010119970101        N                           
J144100100PINJECTION, FILGRASTIM (G-CSF), 480 MCG                                          Filgrastim 480 mcg injection51      A                  2049                                                                               D                          O1E 1P      1994010119970101        N                           
J145000100PINJECTION FLUCONAZOLE, 200 MG                                                   Fluconazole                 51      A                  2049.5                                                                             D                          O1E 1P      2000010120000101        N                           
J145100100PINJECTION, FOMEPIZOLE, 15 MG                                                    Fomepizole, 15 mg           51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J145200100PINJECTION, FOMIVIRSEN SODIUM, INTRAOCULAR, 1.65 MG                              Intraocular Fomivirsen na   51      A                  2049.3                                                                             D                          O1E 1P      2001010120010101        N                           
J145500100PINJECTION, FOSCARNET SODIUM, PER 1000 MG                                        Foscarnet sodium injection  51      A                  2049                                                                               D                          O1E 1P      1993010119970101        N                           
J145700100PINJECTION, GALLIUM NITRATE, 1 MG                                                Gallium nitrate injection   51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J146000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC                                  Gamma globulin 1 CC inj     51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J147000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC                                  Gamma globulin 2 CC inj     51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J148000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC                                  Gamma globulin 3 CC inj     51      A                  2049                                                                               D                          O1E 1P      1985010119970101        N                           
J149000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC                                  Gamma globulin 4 CC inj     51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J150000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC                                  Gamma globulin 5 CC inj     51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J151000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC                                  Gamma globulin 6 CC inj     51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J152000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC                                  Gamma globulin 7 CC inj     51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J153000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC                                  Gamma globulin 8 CC inj     51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J154000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC                                  Gamma globulin 9 CC inj     51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J155000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC                                 Gamma globulin 10 CC inj    51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J156000100PINJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC                            Gamma globulin > 10 CC inj  51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J156100100PINJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 500 MG                                 Immune globulin 500 mg      51      A                  2049                                                                               D                          O1E 1P      199001012003010120021231N                           
J156300100PINJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 1G                                     IV immune globulin          00      9                                                                                                     I                          O1E 1P      200101012006010120051231D                           
J156400100PINJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 10 MG                                  Immune globulin 10 mg       00      9                                                                                                     I                          O1E 1P      200301012006010120051231D                           
J156500100PINJECTION, RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN, INTRAVENOUS, 50 MG      RSV-ivig                    51      A                  2049                                                                               D                          O1E 1P      1998010119980101        N                           
J156600100PINJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. POWDER), 500 MG      Immune globulin, powder     51      A                  2049                                                                               D                          O1E 1P      2006010120060101        A                           
J156700100PINJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG  Immune globulin, liquid     51      A                  2049                                                                               D                          O1E 1P      2006010120060101        A                           
J157000100PINJECTION, GANCICLOVIR SODIUM, 500 MG                                           Ganciclovir sodium injection51      A                  2049                                                                               D                          O1E 1P      1994010119970101        N                           
J158000100PINJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG                                   Garamycin gentamicin inj    51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J159000100PINJECTION, GATIFLOXACIN, 10MG                                                   Gatifloxacin injection      51      A                                                                                                     C                          O1E 1P      2002010120020101        N                           
J159500100PINJECTION, GLATIRAMER ACETATE, 20 MG                                            Injection glatiramer acetate51      A                  2049                                                                               D                          O1E 1P      2004010120040101        N                           
J160000100PINJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG                                  Gold sodium thiomaleate inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J161000100PINJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG                                     Glucagon hydrochloride/1 MG 51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J162000100PINJECTION, GONADORELIN HYDROCHLORIDE, PER 100 MCG                               Gonadorelin hydroch/ 100 mcg51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J162600100PINJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG                                   Granisetron HCl injection   51      A                  2049                                                                               D                          O1E 1P      1998010119980101        N                           
J163000100PINJECTION, HALOPERIDOL, UP TO 5 MG                                              Haloperidol injection       51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J163100100PINJECTION, HALOPERIDOL DECANOATE, PER 50 MG                                     Haloperidol decanoate inj   51      A                  2049                                                                               D                          O1E 1P      1989010119970101        N                           
J164000100PINJECTION, HEMIN, 1 MG                                                          Hemin, 1 mg                 51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J164200100PINJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS                   Inj heparin sodium per 10 u 51      A                  2049                                                                               D                          O1E 1P      1995010119970101        N                           
J164400100PINJECTION, HEPARIN SODIUM, PER 1000 UNITS                                       Inj heparin sodium per 1000u51      A                  2049                                                                               D                          O1E 1LP     1995010120030101        N                           
J164500100PINJECTION, DALTEPARIN SODIUM, PER 2500 IU                                       Dalteparin sodium           51      A                  2049                                                                               D                          O1E 1P      1997010120020701        N                           
J165000100PINJECTION, ENOXAPARIN SODIUM, 10 MG                                             Inj enoxaparin sodium       51      A                                                                                                     C                          O1E 1P      1996010120040101        N                           
J165200100PINJECTION, FONDAPARINUX SODIUM, 0.5 MG                                          Fondaparinux sodium         51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J165500100PINJECTION, TINZAPARIN SODIUM, 1000 IU                                           Tinzaparin sodium injection 51      A                                                                                                     C                          O1E 1P      2002010120020701        N                           
J167000100PINJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS                      Tetanus immune globulin inj 51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J167500100PINJECTION, HISTRELIN ACETATE, 10 MICROGRAMS                                     Histrelin acetate           51      A                  2049                                                                               D                      0095O1E 1G      2006010120060101        A                           
J170000100PINJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG                                  Hydrocortisone acetate inj  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J171000100PINJECTION, HYDROCORTISONE SODIUM  PHOSPHATE, UP TO 50 MG                        Hydrocortisone sodium ph inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J172000100PINJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG                        Hydrocortisone sodium succ i51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J173000100PINJECTION, DIAZOXIDE, UP TO 300 MG                                              Diazoxide injection         51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J174200100PINJECTION, IBUTILIDE FUMARATE, 1 MG                                             Ibutilide fumarate injection51      A                  2049                                                                               D                          O1E 1P      1998010119980101        N                           
J174500100PINJECTION INFLIXIMAB, 10 MG                                                     Infliximab injection        51      A                  2049                                                                               D                          O1E 1P      2000010120000101        N                           
J175000100PINJECTION, IRON DEXTRAN, 50 MG                                                  Iron dextran                51      A                  2049.5                                                                             D                          O1E 1P      200001012006010120051231D                           
J175100100PINJECTION, IRON DEXTRAN 165, 50 MG                                              Iron dextran 165 injection  51      A                                                                                                     D                      0123O1E 1P      2006010120060101        A                           
J175200100PINJECTION, IRON DEXTRAN 267, 50 MG                                              Iron dextran 267 injection  51      A                                                                                                     D                      0123O1E 1P      2006010120060101        A                           
J175500100PINJECTION, IRON SUCROSE, 20MG                                                   Iron sucrose injection      51      A                                                                                                     C                          O1E 1P      200201012003010120021231N                           
J175600100PINJECTION, IRON SUCROSE, 1 MG                                                   Iron sucrose injection      51      A                                                                                                     C                          O1E 1P      2003010120030101        N                           
J178500100PINJECTION, IMIGLUCERASE, PER UNIT                                               Injection imiglucerase /unit51      A                  2049                                                                               D                          O1E 1P      1995010119970101        N                           
J179000100PINJECTION, DROPERIDOL, UP TO 5 MG                                               Droperidol injection        51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J180000100PINJECTION, PROPRANOLOL HCL, UP TO 1 MG                                          Propranolol injection       51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J181000100PINJECTION, DROPERIDOL AND FENTANYL CITRATE, UP TO 2 ML AMPULE                   Droperidol/fentanyl inj     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J181500100PINJECTION, INSULIN, PER 5 UNITS                                                 Insulin injection           51      A60-14             2049                                                                               D                          O1E 1P      2003010120030101        N                           
J181700100PINSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS        Insulin for insulin pump use51      A                                                                                                     C                          D1G 1P      2003010120030101        N                           
J182000100PINJECTION, INSULIN, UP TO 100 UNITS                                             Insulin injection           51      A60-14             2049                                                      J1815                    D                          O1E 1P      198601012003010120021231N                           
J182500100PINJECTION, INTERFERON BETA-1A, 33 MCG                                           Interferon beta-1a          00      9                                                                                                     I                          O1E 1       1998010120030101        N                           
J183000100PINJECTION INTERFERON BETA-1B, 0.25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG  Interferon beta-1b / .25 MG 51      A                  2049                                                                               D                          O1E 1       1982010120000101        N                           
J183000200QADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR  USE WHEN                                                                                                                                                                                                                                          
J183000300QDRUG IS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                           
J183500100PINJECTION, ITRACONAZOLE, 50 MG                                                  Itraconazole injection      51      A                                                                                                     C                          O1E 1P      2002010120020101        N                           
J184000100PINJECTION, KANAMYCIN SULFATE, UP TO 500 MG                                      Kanamycin sulfate 500 MG inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J185000100PINJECTION, KANAMYCIN SULFATE, UP TO 75 MG                                       Kanamycin sulfate 75 MG inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J188500100PINJECTION, KETOROLAC TROMETHAMINE, PER 15 MG                                    Ketorolac tromethamine inj  51      A                  2049                                                                               D                          O1E 1P      1993010119970101        N                           
J189000100PINJECTION, CEPHALOTHIN SODIUM, UP TO 1 GRAM                                     Cephalothin sodium injection51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J191000100PINJECTION, KUTAPRESSIN, UP TO 2 ML                                              Kutapressin injection       51      A                  2049                                                                               D                          O1E 1P      198601012004010120031231N                           
J193100100PINJECTION, LARONIDASE, 0.1 MG                                                   Laronidase injection        51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J194000100PINJECTION, FUROSEMIDE, UP TO 20 MG                                              Furosemide injection        51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J194500100PINJECTION, LEPIRUDIN, 50 MG                                                     Lepirudin                   51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J195000100PINJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG               Leuprolide acetate /3.75 MG 51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J195500100PINJECTION, LEVOCARNITINE, PER 1 GM                                              Inj levocarnitine per 1 gm  51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J195600100PINJECTION, LEVOFLOXACIN, 250 MG                                                 Levofloxacin injection      51      A                  2049                                                                               D                          O1E 1P      1999010119990101        N                           
J196000100PINJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG                                     Levorphanol tartrate inj    51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J198000100PINJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG                                   Hyoscyamine sulfate inj     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J199000100PINJECTION, CHLORDIAZEPOXIDE HCL, UP TO 100 MG                                   Chlordiazepoxide injection  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J200000100PINJECTION, LIDOCAINE HCL, 50 CC                                                 Lidocaine injection         51      A                  2049                                                                               D                          O1E 1P      198601012004010120031231N                           
J200100100PINJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG                        Lidocaine injection         51      A                  2049                                                                               D                          O1E 1P      2004010120040101        N                           
J201000100PINJECTION, LINCOMYCIN HCL, UP TO 300 MG                                         Lincomycin injection        51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J202000100PINJECTION, LINEZOLID, 200MG                                                     Linezolid injection         51      A                                                                                                     C                          O1E 1P      2002010120020101        N                           
J206000100PINJECTION, LORAZEPAM, 2 MG                                                      Lorazepam injection         51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J215000100PINJECTION, MANNITOL, 25% IN 50 ML                                               Mannitol injection          51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J217500100PINJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG                                 Meperidine hydrochl /100 MG 51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J218000100PINJECTION, MEPERIDINE AND PROMETHAZINE HCL, UP TO 50 MG                         Meperidine/promethazine inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J218500100PINJECTION, MEROPENEM, 100 MG                                                    Meropenem                   51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J221000100PINJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG                               Methylergonovin maleate inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J225000100PINJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG                                    Inj midazolam hydrochloride 51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J226000100PINJECTION, MILRINONE LACTATE, 5 MG                                              Inj milrinone lactate / 5 MG51      A                  2049                                                                               D                          O1E 1P      1986010120010101        N                           
J227000100PINJECTION, MORPHINE SULFATE, UP TO 10 MG                                        Morphine sulfate injection  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J227100100PINJECTION, MORPHINE SULFATE, 100MG                                              Morphine so4 injection 100mg51      A60-14a            2049                                                                               D                          O1E 1P      1999010120010101        N                           
J227500100PINJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE SOLUTION), PER 10 MG     Morphine sulfate injection  51      A60-14b            2049                                                                               D                          O1E 1P      1993010120010101        N                           
J227800100PINJECTION, ZICONOTIDE, 1 MICROGRAM                                              Ziconotide injection        51      A                                                                                                     D                      0123O1E 1P      2006010120060101        A                           
J228000100PINJECTION, MOXIFLOXACIN, 100 MG                                                 Inj, moxifloxacin 100 mg    51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J230000100PINJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG                                  Inj nalbuphine hydrochloride51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J231000100PINJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG                                     Inj naloxone hydrochloride  51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J232000100PINJECTION, NANDROLONE DECANOATE, UP TO 50 MG                                    Nandrolone decanoate 50 MG  51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J232100100PINJECTION, NANDROLONE DECANOATE, UP TO 100 MG                                   Nandrolone decanoate 100 MG 51      A                  2049                                                                               D                          O1E 1P      1987010119970101        N                           
J232200100PINJECTION, NANDROLONE DECANOATE, UP TO 200 MG                                   Nandrolone decanoate 200 MG 51      A                  2049                                                                               D                          O1E 1P      1987010119970101        N                           
J232400100PINJECTION, NESIRITIDE, 0.25 MG                                                  Nesiritide                  51      A                  2049                                                                               D                          O1E 1P      200301012006010120051231D                           
J232500100PINJECTION, NESIRITIDE, 0.1 MG                                                   Nesiritide injection        51      A                  2049                                                                               D                          O1E 1P      2006010120060101        A                           
J235200100PINJECTION, OCTREOTIDE ACETATE, 1 MG                                             Octreotide acetate injection51      A                  2049                                                                               D                          O1E 1P      200001012004010120031231N                           
J235300100PINJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG             Octreotide injection, depot 51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J235400100PINJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS           Octreotide inj, non-depot   51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J235400200QINJECTION, 25 MCG                                                                                                                                                                                                                                                                                                    
J235500100PINJECTION, OPRELVEKIN, 5 MG                                                     Oprelvekin injection        51      A                  2049                                                                               D                          O1E 1P      1999010119990101        N                           
J235700100PINJECTION, OMALIZUMAB, 5 MG                                                     Omalizumab injection        51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J236000100PINJECTION, ORPHENADRINE CITRATE, UP TO 60 MG                                    Orphenadrine injection      51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J237000100PINJECTION, PHENYLEPHRINE HCL, UP TO 1 ML                                        Phenylephrine hcl injection 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J240000100PINJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30 ML                              Chloroprocaine hcl injection51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J240500100PINJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG                                  Ondansetron hcl injection   51      A                  2049                                                                               D                          O1E 1P      1993010119970101        N                           
J241000100PINJECTION, OXYMORPHONE HCL, UP TO 1 MG                                          Oxymorphone hcl injection   51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J242500100PINJECTION, PALIFERMIN, 50 MICROGRAMS                                            Palifermin injection        51      A                                                                                                     C                          O1E 1P      2006010120060101        A                           
J243000100PINJECTION, PAMIDRONATE DISODIUM, PER 30 MG                                      Pamidronate disodium /30 MG 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J244000100PINJECTION, PAPAVERINE HCL, UP TO 60 MG                                          Papaverin hcl injection     51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J246000100PINJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG                                     Oxytetracycline injection   51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J246900100PINJECTION, PALONOSETRON HCL, 25 MCG                                             Palonosetron HCl            51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J250000100PINJECTION, PARICALCITOL, 5 MCG                                                  Paricalcitol                51      A                  2049                                                                               D                          O1E 1P      200001012003010120021231N                           
J250100100PINJECTION, PARICALCITOL, 1 MCG                                                  Paricalcitol                51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J250300100PINJECTION, PEGAPTANIB SODIUM, 0.3 MG                                            Pegaptanib sodium injection 51      A                                                                                                     C                      0095O1E 1P      2006010120060101        A                           
J250400100PINJECTION, PEGADEMASE BOVINE, 25 IU                                             Pegademase bovine, 25 iu    51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J250500100PINJECTION, PEGFILGRASTIM, 6 MG                                                  Injection, pegfilgrastim 6mg53      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J251000100PINJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS                  Penicillin g procaine inj   51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J251300100PINJECTION, PENTASTARCH, 10% SOLUTION, 100 ML                                    Pentastarch 10% solution    51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J251500100PINJECTION, PENTOBARBITAL SODIUM, PER 50 MG                                      Pentobarbital sodium inj    51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J254000100PINJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS                          Penicillin g potassium inj  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J254300100PINJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125     Piperacillin/tazobactam     51      A                  2049                                                                               D                          O1E 1P      2000010120010101        N                           
J254300200QGRAMS)                                                                                                                                                                                                                                                                                                               
J254500100PPENTAMIDINE ISETHIONATE, INHALATION SOLUTION, PER 300 MG, ADMINISTERED THROUGH  Pentamidine isethionte/300mg51      A                  2049                                                                               D                      0018D1G 1P      1992010119970101        N                           
J254500200QA DME                                                                                                                                                                                                                                                                                                                
J255000100PINJECTION, PROMETHAZINE HCL, UP TO 50 MG                                        Promethazine hcl injection  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J256000100PINJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG                                   Phenobarbital sodium inj    51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J259000100PINJECTION, OXYTOCIN, UP TO 10 UNITS                                             Oxytocin injection          51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J259700100PINJECTION, DESMOPRESSIN ACETATE, PER 1 MCG                                      Inj desmopressin acetate    51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J265000100PINJECTION, PREDNISOLONE ACETATE, UP TO 1 ML                                     Prednisolone acetate inj    51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J267000100PINJECTION, TOLAZOLINE HCL, UP TO 25 MG                                          Totazoline hcl injection    51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J267500100PINJECTION, PROGESTERONE, PER 50 MG                                              Inj progesterone per 50 MG  51      A                  2049                                                                               D                          O1E 1P      1986010120020701        N                           
J268000100PINJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG                                  Fluphenazine decanoate 25 MG51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J269000100PINJECTION, PROCAINAMIDE HCL, UP TO 1 GM                                         Procainamide hcl injection  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J270000100PINJECTION, OXACILLIN SODIUM, UP TO 250 MG                                       Oxacillin sodium injeciton  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J271000100PINJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG                              Neostigmine methylslfte inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J272000100PINJECTION, PROTAMINE SULFATE, PER 10 MG                                         Inj protamine sulfate/10 MG 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J272500100PINJECTION, PROTIRELIN, PER 250 MCG                                              Inj protirelin per 250 mcg  51      A                  2049                                                                               D                          O1E 1P      1995010119970101        N                           
J273000100PINJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM                                     Pralidoxime chloride inj    51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J276000100PINJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG                                    Phentolaine mesylate inj    51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J276500100PINJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG                                      Metoclopramide hcl injection51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J277000100PINJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350)                          Quinupristin/dalfopristin   51      A                  2049                                                                               D                          O1E 1P      2001010120010101        N                           
J278000100PINJECTION, RANITIDINE HYDROCHLORIDE, 25 MG                                      Ranitidine hydrochloride inj51      A                  2049                                                                               D                          O1E 1P      2000010120000101        N                           
J278300100PINJECTION, RASBURICASE, 0.5 MG                                                  Rasburicase                 51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J278800100PINJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MCG                       Rho d immune globulin 50 mcg51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J279000100PINJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MCG                     Rho d immune globulin inj   51      A                  2049                                                                               D                          O1E 1P      1986010120030101        N                           
J279200100PINJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU Rho(D) immune globulin h, sd51      A                  2049                                                                               D                          O1E 1P      1999010119990101        N                           
J279400100PINJECTION, RISPERIDONE, LONG ACTING, 0.5 MG                                     Risperidone, long acting    51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J279500100PINJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG                                      Ropivacaine HCl injection   51      A                                                                                                     C                          O1E 1P      2001010120010101        N                           
J280000100PINJECTION, METHOCARBAMOL, UP TO 10 ML                                           Methocarbamol injection     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J280500100PINJECTION, SINCALIDE, 5 MICROGRAMS                                              Sincalide injection         51      A                                                                                                     C                          O1E 1P      2006010120060101        A                           
J281000100PINJECTION, THEOPHYLLINE, PER 40 MG                                              Inj theophylline per 40 MG  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J282000100PINJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG                                        Sargramostim injection      51      A                  2049                                                                               D                          O1E 1P      1982010119980101        N                           
J285000100PINJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM                              Inj secretin synthetic human51      A                  2049                                                                               D                          O1E 1P      2006010120060101        A                           
J291000100PINJECTION, AUROTHIOGLUCOSE, UP TO 50 MG                                         Aurothioglucose injeciton   51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J291200100PINJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML                                      Sodium chloride injection   51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J291500100PINJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 62.5 MG        NA Ferric Gluconate Complex 51      A                  2049.2  2049.4                                                                     D                          O1E 1P      200101012003010120021231N                           
J291600100PINJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG        Na ferric gluconate complex 51      A                  2049.2  2049.4                                                                     D                          O1E 1P      2003010120030101        N                           
J292000100PINJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG                     Methylprednisolone injection51      A                  2049                                                                               D                          O1E 1G      1982010119970101        N                           
J293000100PINJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG                    Methylprednisolone injection51      A                  2049                                                                               D                          O1E 1G      1984010119970101        N                           
J294000100PINJECTION, SOMATREM, 1 MG                                                       Somatrem injection          51      A                  2049                    1861s2b                                                    D                          O1E 1P      2002010120020101        N                           
J294100100PINJECTION, SOMATROPIN, 1 MG                                                     Somatropin injection        51      A                  2049                    1861s2b                                                    D                          O1E 1P      2002010120020101        N                           
J295000100PINJECTION, PROMAZINE HCL, UP TO 25 MG                                           Promazine hcl injection     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J299300100PINJECTION, RETEPLASE, 18.1 MG                                                   Reteplase injection         51      A                  2049                                                                               D                          O1E 1P      2001010120010101        N                           
J299500100PINJECTION, STREPTOKINASE, PER 250,000 IU                                        Inj streptokinase /250000 IU51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J299700100PINJECTION, ALTEPLASE RECOMBINANT, 1 MG                                          Alteplase recombinant       51      A                  2049                                                                               D                          O1E 1P      2001010120010101        N                           
J300000100PINJECTION, STREPTOMYCIN, UP TO 1 GM                                             Streptomycin injection      51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J301000100PINJECTION, FENTANYL CITRATE, 0.1 MG                                             Fentanyl citrate injeciton  51      A                  2049                                                                               D                          O1E 1P      1982010120010101        N                           
J303000100PINJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG Sumatriptan succinate / 6 MG51      A                  2049                                                                               D                          O1E 1P      1986010120000101        N                           
J303000200QADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG                                                                                                                                                                                                                                      
J303000300QIS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                                
J307000100PINJECTION, PENTAZOCINE, 30 MG                                                   Pentazocine injection       51      A                  2049                                                                               D                          O1E 1P      1982010120030101        N                           
J310000100PINJECTION, TENECTEPLASE, 50MG                                                   Tenecteplase injection      51      A                                                                                                     C                          O1E 1P      2002010120020101        N                           
J310500100PINJECTION, TERBUTALINE SULFATE, UP TO 1 MG                                      Terbutaline sulfate inj     51      A                  2049                                                                               D                          O1E 1P      1987010119970101        N                           
J311000100PINJECTION, TERIPARATIDE, 10 MCG                                                 Teriparatide injection      51      A                                                                                                     D                      0120O1E 1P      2005010120050101        N                           
J312000100PINJECTION, TESTOSTERONE ENANTHATE, UP TO 100 MG                                 Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J313000100PINJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG                                 Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J314000100PINJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG                                 Testosterone suspension inj 51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J315000100PINJECTION, TESTOSTERONE PROPIONATE, UP TO 100 MG                                Testosteron propionate inj  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J323000100PINJECTION, CHLORPROMAZINE HCL, UP TO 50 MG                                      Chlorpromazine hcl injection51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J324000100PINJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIAL                   Thyrotropin injection       51      A                  2049                                                                               D                          O1E 1P      1986010120030101        N                           
J324500100PINJECTION, TIROFIBAN HYDROCHLORIDE, 12.5 MG                                     Tirofiban hydrochloride     51      A                  2049                                                                               D                          O1E 1P      200001012005010120041231N                           
J324600100PINJECTION, TIROFIBAN HCL, 0.25MG                                                Tirofiban HCl               51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J325000100PINJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG                                  Trimethobenzamide hcl inj   51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J326000100PINJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG                                      Tobramycin sulfate injection51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J326500100PINJECTION, TORSEMIDE, 10 MG/ML                                                  Injection torsemide 10 mg/ml51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J328000100PINJECTION, THIETHYLPERAZINE MALEATE, UP TO 10 MG                                Thiethylperazine maleate inj51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J328500100PINJECTION, TREPROSTINIL, 1 MG                                                   Treprostinil injection      51      A                                                                                                     C                          O1E 1P      2006010120060101        A                           
J330100100PINJECTION, TRIAMCINOLONE  ACETONIDE, PER 10MG                                   Triamcinolone acetonide inj 51      A                  2049                                                                               D                          O1E 1P      1991010119970101        N                           
J330200100PINJECTION, TRIAMCINOLONE DIACETATE, PER 5MG                                     Triamcinolone diacetate inj 51      A                  2049                                                                               D                          O1E 1P      1991010119970101        N                           
J330300100PINJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG                                  Triamcinolone hexacetonl inj51      A                  2049                                                                               D                          O1E 1P      1991010119970101        N                           
J330500100PINJECTION, TRIMETREXATE GLUCURONATE, PER 25 MG                                  Inj trimetrexate glucoronate51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J331000100PINJECTION, PERPHENAZINE, UP TO 5 MG                                             Perphenazine injeciton      51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J331500100PINJECTION, TRIPTORELIN PAMOATE, 3.75 MG                                         Triptorelin pamoate         51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
J332000100PINJECTION, SPECTINOMYCIN DIHYDROCHLORIDE, UP TO 2 GM                            Spectinomycn di-hcl inj     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J335000100PINJECTION, UREA, UP TO 40 GM                                                    Urea injection              51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J335500100PINJECTION, UROFOLLITROPIN, 75 IU                                                Urofollitropin, 75 iu       51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J336000100PINJECTION, DIAZEPAM, UP TO 5 MG                                                 Diazepam injection          51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J336400100PINJECTION, UROKINASE, 5000 IU VIAL                                              Urokinase 5000 IU injection 51      A                  2049                                                                               D                          O1E 1P      1993010119970101        N                           
J336500100PINJECTION, IV, UROKINASE, 250,000 I.U. VIAL                                     Urokinase 250,000 IU inj    51      A                  2049                                                      Q0089                    D                          O1E 1P      1992010119970101        N                           
J337000100PINJECTION, VANCOMYCIN HCL, 500 MG                                               Vancomycin hcl injection    51      A60-14             2049                                                                               D                          O1E 1P      1986010120000101        N                           
J339500100PINJECTION, VERTEPORFIN, 15MG                                                    Verteporfin injection       51      A35-10045-30                                                                                          D                          O1E 1P      200201012005010120041231N                           
J339600100PINJECTION, VERTEPORFIN, 0.1 MG                                                  Verteporfin injection       51      A                  35-100  45-30                                                                      D                          O1E 9       2005010120050101        N                           
J340000100PINJECTION, TRIFLUPROMAZINE HCL, UP TO 20 MG                                     Triflupromazine hcl inj     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J341000100PINJECTION, HYDROXYZINE HCL, UP TO 25 MG                                         Hydroxyzine hcl injection   51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J341100100PINJECTION, THIAMINE HCL, 100 MG                                                 Thiamine hcl 100 mg         51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J341500100PINJECTION, PYRIDOXINE HCL, 100 MG                                               Pyridoxine hcl 100 mg       51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J342000100PINJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP  TO 1000 MCG                         Vitamin b12 injection       51      A45-4              2049                                                                               D                          O1E 1P      1986010119970101        N                           
J343000100PINJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG                                   Vitamin k phytonadione inj  51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J346500100PINJECTION, VORICONAZOLE, 10 MG                                                  Injection, voriconazole     51      A                  2049                                                                               D                          O1E 1P      2004010120040101        N                           
J347000100PINJECTION, HYALURONIDASE, UP TO 150 UNITS                                       Hyaluronidase injection     51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J347100100PINJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1 USP UNIT (UP TO 999   Ovine, up to 999 USP units  51      A                                                                                                     D                      0123O1E 1P      2006010120060101        A                           
J347100200QUSP UNITS)                                                                                                                                                                                                                                                                                                           
J347200100PINJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1000 USP UNITS          Ovine, 1000 USP units       51      A                                                                                                     D                      0123O1E 1P      2006010120060101        A                           
J347500100PINJECTION, MAGNESIUM SULFATE, PER 500 MG                                        Inj magnesium sulfate       51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J348000100PINJECTION, POTASSIUM CHLORIDE, PER 2 MEQ                                        Inj potassium chloride      51      A                  2049                                                                               D                          O1E 1P      1996010119970101        N                           
J348500100PINJECTION, ZIDOVUDINE, 10 MG                                                    Zidovudine                  51      A                  2049                                                                               D                          O1E 1P      2001010120010101        N                           
J348600100PINJECTION, ZIPRASIDONE MESYLATE, 10 MG                                          Ziprasidone mesylate        51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J348700100PINJECTION, ZOLEDRONIC ACID, 1 MG                                                Zoledronic acid             51      A                                                                                                     C                          O1E 1P      2003010120030101        N                           
J349000100PUNCLASSIFIED DRUGS                                                              Drugs unclassified injection51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J352000100PEDETATE DISODIUM, PER 150 MG                                                    Edetate disodium per 150 mg 00      935-64 45-20                                                                                          M                          O1E 1P      1986010119960101        N                           
J353000100PNASAL VACCINE INHALATION                                                        Nasal vaccine inhalation    51      A                  2049                                                                               D                          O1E 1P      1986010119970101        N                           
J353500100PDRUG ADMINISTERED THROUGH A METERED DOSE INHALER                                Metered dose inhaler drug   00      9                  2050.5                                                                             M                          O1E 1P      1994010119970101        N                           
J357000100PLAETRILE, AMYGDALIN, VITAMIN B17                                                Laetrile amygdalin vit B17  00      945-10                                                                                                M                          O1E 1P      1986010119960101        N                           
J359000100PUNCLASSIFIED BIOLOGICS                                                          Unclassified biologics      51      A                                                                                                     C                          O1E 1P      2003010120030101        N                           
J703000100PINFUSION, NORMAL SALINE SOLUTION , 1000 CC                                      Normal saline solution infus51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J704000100PINFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)                       Normal saline solution infus51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J704200100P5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)                                     5% dextrose/normal saline   51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J705000100PINFUSION, NORMAL SALINE SOLUTION , 250 CC                                       Normal saline solution infus51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J705100100PSTERILE SALINE OR WATER, UP TO 5 CC                                             Sterile saline/water        51      A                  2049                                                                               D                          O1E 1P      199401012006010120051231D                           
J706000100P5% DEXTROSE/WATER (500 ML = 1 UNIT)                                             5% dextrose/water           51      A                  2049                                                                               D                          O1E 1P      1985010119970101        N                           
J707000100PINFUSION, D5W, 1000 CC                                                          D5w infusion                51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J710000100PINFUSION, DEXTRAN 40, 500 ML                                                    Dextran 40 infusion         51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J711000100PINFUSION, DEXTRAN 75, 500 ML                                                    Dextran 75 infusion         51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J712000100PRINGERS LACTATE INFUSION, UP TO 1000 CC                                         Ringers lactate infusion    51      A                  2049                                                                               D                          O1E 1P      1982010119970101        N                           
J713000100PHYPERTONIC SALINE SOLUTION, 50 OR 100 MEQ, 20 CC VIAL                           Hypertonic saline solution  51      A                  2049                                                                               D                          O1E 1P      1984010119970101        N                           
J718800100PINJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU                             Inj Vonwillebrand factor iu 51      A35.30             2049.5                                                                             D                      0095O1E 1P      2006010120060101        A                           
J718900100PFACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PER 1 MICROGRAM               Factor viia                 51      A                  2049                                                                               D                          O1E 1P      2006010120060101        A                           
J719000100PFACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.                             Factor viii                 51      A                  2049                                                                               D                          O1E 1P      1986010119990101        N                           
J719100100PFACTOR VIII (ANTIHEMOPHILIC FACTOR (PORCINE)), PER I.U.                         Factor VIII (porcine)       51      A                  2049                                                                               D                          O1E 1P      1996010119980101        N                           
J719200100PFACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.                       Factor viii recombinant     51      A                  2049                                                                               D                          O1E 1P      1994010119990101        N                           
J719300100PFACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U.           Factor IX non-recombinant   51      A                  2049                                                                               D                          O1E 1P      2002010120020101        N                           
J719400100PFACTOR IX, COMPLEX, PER I.U.                                                    Factor ix complex           51      A                  2049                                                                               D                          O1E 1P      1986010119980101        N                           
J719500100PFACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.                         Factor IX recombinant       51      A                  2049                                                                               D                          O1E 1P      2002010120020101        N                           
J719700100PANTITHROMBIN III (HUMAN), PER I.U.                                              Antithrombin iii injection  51      A                  2049                                                                               D                          O1E 1P      1992010119970101        N                           
J719800100PANTI-INHIBITOR, PER I.U.                                                        Anti-inhibitor              51      A45-24             2049                                                                               D                          O1E 1P      2000010120000101        N                           
J719900100PHEMOPHILIA CLOTTING FACTOR, NOT OTHERWISE CLASSIFIED                            Hemophilia clot factor noc  51      A45-24             2049                                                                               D                          O1E 1P      2000010120000101        N                           
J730000100PINTRAUTERINE COPPER CONTRACEPTIVE                                               Intraut copper contraceptive00      9                                          1862A1                                                     S                          P6C 9       1986010119950401        N                           
J730200100PLEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM, 52 MG               Levonorgestrel iu contracept00      9                                          1862a1                                                     S                          P6C 9       2002010120020101        N                           
J730300100PCONTRACEPTIVE SUPPLY, HORMONE CONTAINING VAGINAL RING, EACH                     Contraceptive vaginal ring  00      9                                          1862.1                                                     S                          Z2  9       2004010120040101        N                           
J730400100PCONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH                            Contraceptive hormone patch 00      9                                          1862.1                                                     S                          Z2  9       2005010120050101        N                           
J730600100PLEVONORGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLANTS AND SUPPLIES  Levonorgestrel implant sys  00      9                                                                                                     I                          P6C 9       2006010120060101        A                           
J730800100PAMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOSAGE     Aminolevulinic acid hcl top 51      A                                                                                                     C                          O1E 1       2002010120040101        N                           
J730800200QFORM (354 MG)                                                                                                                                                                                                                                                                                                        
J731000100PGANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT                                        Ganciclovir long act implant51      A                  2049                                                                               D                          O1E 9       1997010119970101        N                           
J731600100PSODIUM HYALURONATE, 5 MG FOR INTRA-ARTICULAR INJECTION                          Sodium hyaluronate injection00      9                                                                            J7317                    I                          O1E 1       200201012003010120021231N                           
J731700100PSODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR INJECTION          Sodium hyaluronate injection51      A                                                                                                     C                          O1E 1       2003010120030101        N                           
J732000100PHYLAN G-F 20, 16 MG, FOR INTRA ARTICULAR INJECTION                              Hylan G-F 20 injection      51      A                                                                                                     C                          O1E 1       1999010119990101        N                           
J733000100PAUTOLOGOUS CULTURED CHONDROCYTES, IMPLANT                                       Cultured chondrocytes implnt57      A                                                                                                     C                          O1E 1P      2001010120020701        N                           
J734000100PDERMAL AND EPIDERMAL, (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT      Metabolic active D/E tissue 51      A                                                                                                     C                          O1E 1       2002010120060101        C                           
J734000200QBIOENGINEERED OR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER                                                                                                                                                                                                                                         
J734000300QSQUARE CENTIMETER                                                                                                                                                                                                                                                                                                    
J734100100PDERMAL (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER           Non-human, metabolic tissue 51      A                                                                                                     C                          O1E 1       2006010120060101        A                           
J734100200QBIOENGINEERED OR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER                                                                                                                                                                                                                                         
J734100300QSQUARE CENTIMETER                                                                                                                                                                                                                                                                                                    
J734200100PDERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED Metabolically active tissue 46      A                                                                                                     C                          O1E 1       2003010120060101        C                           
J734200200QOR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER                                                                                                                                                                                                                                     
J734300100PDERMAL AND EPIDERMAL, (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT  Nonmetabolic act d/e tissue 51      A                                                                                                     C                          O1E 1       2005010120060101        C                           
J734300200QOTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE                                                                                                                                                                                                                                              
J734300300QELEMENTS, PER SQUARE CENTIMETER                                                                                                                                                                                                                                                                                      
J734400100PDERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED Nonmetabolic active tissue  51      A                                                                                                     C                          O1E 1       2005010120060101        C                           
J734400200QOR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE                                                                                                                                                                                                                                             
J734400300QCENTIMETER                                                                                                                                                                                                                                                                                                           
J735000100PDERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, INJECTABLE, WITH OR WITHOUT OTHER   Injectable human tissue     51      A                                                                                                     C                          O1E 1S      2003010120060101        C                           
J735000200QBIOENGINEERED OR PROCESSED ELEMENTS, BUT WITHOUT METABOLIZED ACTIVE ELEMENTS,                                                                                                                                                                                                                                        
J735000300QPER 10 MG                                                                                                                                                                                                                                                                                                            
J750000100PAZATHIOPRINE, ORAL, 50 MG                                                       Azathioprine oral 50mg      51      A                  2049.5                                                                             D                          O1E 1G      1988010120000101        N                           
J750100100PAZATHIOPRINE, PARENTERAL, 100 MG                                                Azathioprine parenteral     51      A                  2049                                                                               D                          O1E 1G      1988010120000101        N                           
J750200100PCYCLOSPORINE, ORAL, 100 MG                                                      Cyclosporine oral 100 mg    57      A                  2049.5                                                                             D                          O1E 1G      2000010120000101        N                           
J750400100PLYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, EQUINE, PARENTERAL, 250 MG  Lymphocyte immune globulin  51      A45-22             2049                                                                               D                          O1E 1G      1988010120020101        N                           
J750500100PMUROMONAB-CD3, PARENTERAL, 5 MG                                                 Monoclonal antibodies       51      A                  2049                                                                               D                          O1E 1G      1988010120010101        N                           
J750600100PPREDNISONE, ORAL, PER 5MG                                                       Prednisone oral             51      A                  2049.5                                                                             D                          O1E 1G      1989010120000101        N                           
J750700100PTACROLIMUS, ORAL, PER 1 MG                                                      Tacrolimus oral per 1 MG    51      A                  2049.5                                                                             D                          O1E 1G      1995010120000101        N                           
J750800100PTACROLIMUS, ORAL, PER 5 MG                                                      Tacrolimus oral per 5 MG    51      A                  2049.5                                                                             D                          O1E 1G      199501012004010120031231N                           
J750900100PMETHYLPREDNISOLONE ORAL, PER 4 MG                                               Methylprednisolone oral     51      A                  2049.5                                                                             D                          O1E 1G      1996010120000101        N                           
J751000100PPREDNISOLONE ORAL, PER 5 MG                                                     Prednisolone oral per 5 mg  51      A                  2049.5                                                                             D                          O1E 1G      1996010120000101        N                           
J751100100PLYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, 25MG    Antithymocyte globuln rabbit51      A                                                                                                     C                          O1E 1G      2002010120020101        N                           
J751300100PDACLIZUMAB, PARENTERAL, 25 MG                                                   Daclizumab, parenteral      51      A                  2049.5                                                                             D                          O1E 1G      1999010120000101        N                           
J751500100PCYCLOSPORINE, ORAL, 25 MG                                                       Cyclosporine oral 25 mg     51      A                                                                                                     C                          O1E 1G      2000010120000101        N                           
J751600100PCYCLOSPORIN, PARENTERAL, 250 MG                                                 Cyclosporin parenteral 250mg51      A                                                                                                     C                          O1E 1G      2000010120000101        N                           
J751700100PMYCOPHENOLATE MOFETIL, ORAL, 250 MG                                             Mycophenolate mofetil oral  51      A                                                                                                     C                          O1E 1G      2000010120000101        N                           
J751800100PMYCOPHENOLIC ACID, ORAL, 180 MG                                                 Mycophenolic acid           51      A                  2050.5  4471    5249                                                               D                          O1E 1G      2005010120050101        N                           
J752000100PSIROLIMUS, ORAL, 1 MG                                                           Sirolimus, oral             51      A                  2049.5                                                                             D                          O1E 1G      2001010120010101        N                           
J752500100PTACROLIMUS, PARENTERAL, 5 MG                                                    Tacrolimus injection        51      A                  2049.5                                                                             D                          O1E 1G      2001010120010101        N                           
J759900100PIMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED                                Immunosuppressive drug noc  51      A                  2049.5                                                                             D                          O1E 1G      1996010120000101        N                           
J760800100PACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,   Acetylcysteine inh sol u d  51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J760800200QPER GRAM                                                                                                                                                                                                                                                                                                             
J761100100PALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 1  Albuterol concentrated form 51      A                  2100.5                                                                             D                          D1G 1P      2005010120050101        N                           
J761100200QMG                                                                                                                                                                                                                                                                                                                   
J761200100PLEVALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, CONCENTRATED FORM, Levalbuterol concentrated   51      A                  2100.5                                                                             D                          D1G 1P      2005010120050101        N                           
J761200200Q0.5 MG                                                                                                                                                                                                                                                                                                               
J761300100PALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG       Albuterol unit dose         51      A                  2100.5                                                                             D                          D1G 1P      2005010120050101        N                           
J761400100PLEVALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG  Levalbuterol unit dose      51      A                  2100.5                                                                             D                          D1G 1P      2005010120050101        N                           
J761600100PALBUTEROL, UP TO 5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED           Albuterol compound solution 51      A                  2100.5                                                                             D                          D1G 1P      200501012006010120051231D                           
J761600200QINHALATION SOLUTION, ADMINISTERED THROUGH DME                                                                                                                                                                                                                                                                        
J761700100PLEVALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED      Levalbuterol compounded sol 51      A                  2100.5                                                                             D                          D1G 1P      200501012006010120051231D                           
J761700200QINHALATION SOLUTION, ADMINISTERED THROUGH DME                                                                                                                                                                                                                                                                        
J761800100PALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION    Albuterol inh sol con       51      A                  2100.5                                                                             D                          D1G 1P      200001012005010120041231N                           
J761800200QADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG                                                                                                                                                                                                                                      
J761800300Q(LEVALBUTEROL)                                                                                                                                                                                                                                                                                                       
J761900100PALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION    Albuterol inh sol u d       51      A                  2100.5                                                                             D                          D1G 1P      200001012005010120041231N                           
J761900200QADMINISTERED THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG                                                                                                                                                                                                                                              
J761900300Q(LEVALBUTEROL)                                                                                                                                                                                                                                                                                                       
J762000100PALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, NON-COMPOUNDED   Albuterol non-compounded    51      A                  2100.5                                                                             D                          D1G 1P      2006010120060101        A                           
J762000200QINHALATION SOLUTION, ADMINISTERED THROUGH DME                                                                                                                                                                                                                                                                        
J762100100PALBUTEROL, ALL FORMULATIONS, INCLUDING SEPARATED ISOMERS, UP TO 5 MG            (Levo)albuterol/Ipra-bromide51      A                                                                                                     C                          D1G 1P      200401012005010120041231N                           
J762100200Q(ALBUTEROL) OR 2.5 MG (LEVOALBUTEROL), AND IPRATROPIUM BROMIDE, UP TO 1 MG,                                                                                                                                                                                                                                          
J762100300QCOMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME                                                                                                                                                                                                                                                             
J762200100PBECLOMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,   Beclomethasone inhalatn sol 51      A                                                                                                     C                          D1G 1P      2002010120020701        N                           
J762200200QPER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J762400100PBETAMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,    Betamethasone inhalation sol51      A                                                                                                     C                          D1G 1P      2002010120020701        N                           
J762400200QPER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J762600100PBUDESONIDE INHALATION SOLUTION, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT  Budesonide, non-compounded  51      A                                                                                                     C                          D1G 1P      2002010120060101        C                           
J762600200QDOSE FORM, UP TO 0.5 MG                                                                                                                                                                                                                                                                                              
J762700100PBUDESONIDE, POWDER, COMPOUNDED FOR INHALATION SOLUTION, ADMINISTERED THROUGH    Budesonide, compounded      51      A                                                                                                     C                          D1G 1P      2006010120060101        A                           
J762700200QDME, UNIT DOSE FORM, UP TO 0.5 MG                                                                                                                                                                                                                                                                                    
J762800100PBITOLTEROL MESYLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED Bitolterol mes inhal sol con51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J762800200QFORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J762900100PBITOLTEROL MESYLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE    Bitolterol mes inh sol u d  51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J762900200QFORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J763100100PCROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,  Cromolyn sodium inh sol u d 51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J763100200QPER 10 MILLIGRAMS                                                                                                                                                                                                                                                                                                    
J763300100PBUDESONIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM,    Budesonide concentrated sol 51      A                                                                                                     C                          D1G 1P      2003010120030101        N                           
J763300200QPER 0.25 MILLIGRAM                                                                                                                                                                                                                                                                                                   
J763500100PATROPINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER  Atropine inhal sol con      51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J763500200QMILLIGRAM                                                                                                                                                                                                                                                                                                            
J763600100PATROPINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER     Atropine inhal sol unit dose51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J763600200QMILLIGRAM                                                                                                                                                                                                                                                                                                            
J763700100PDEXAMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, Dexamethasone inhal sol con 51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J763700200QPER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J763800100PDEXAMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,    Dexamethasone inhal sol u d 51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J763800200QPER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J763900100PDORNASE ALPHA, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,    Dornase alpha inhal sol u d 51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J763900200QPER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J764000100PFORMOTEROL, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, 12    Formoterol injection        00      9                                                                                                     C                          D1G 1P      2006010120060101        A                           
J764000200QMICROGRAMS                                                                                                                                                                                                                                                                                                           
J764100100PFLUNISOLIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE, PER       Flunisolide, inhalation sol 51      A                                                                                                     C                          D1G 1P      2002010120020701        N                           
J764100200QMILLIGRAM                                                                                                                                                                                                                                                                                                            
J764200100PGLYCOPYRROLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED      Glycopyrrolate inhal sol con51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J764200200QFORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J764300100PGLYCOPYRROLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,   Glycopyrrolate inhal sol u d51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J764300200QPER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J764400100PIPRATROPIUM BROMIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE    Ipratropium brom inh sol u d51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J764400200QFORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J764800100PISOETHARINE HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED     Isoetharine hcl inh sol con 51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J764800200QFORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J764900100PISOETHARINE HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,  Isoetharine hcl inh sol u d 51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J764900200QPER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J765800100PISOPROTERENOL HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED   Isoproterenolhcl inh sol con51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J765800200QFORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J765900100PISOPROTERENOL HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE      Isoproterenol hcl inh sol ud51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J765900200QFORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J766800100PMETAPROTERENOL SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME,           Metaproterenol inh sol con  51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J766800200QCONCENTRATED FORM, PER 10 MILLIGRAMS                                                                                                                                                                                                                                                                                 
J766900100PMETAPROTERENOL SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE Metaproterenol inh sol u d  51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J766900200QFORM, PER 10 MILLIGRAMS                                                                                                                                                                                                                                                                                              
J767400100PMETHACHOLINE CHLORIDE ADMINISTERED AS INHALATION SOLUTION THROUGH A NEBULIZER,  Methacholine chloride, neb  51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J767400200QPER 1 MG                                                                                                                                                                                                                                                                                                             
J768000100PTERBUTALINE SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED Terbutaline so4 inh sol con 51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J768000200QFORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J768100100PTERBUTALINE SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE    Terbutaline so4 inh sol u d 51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J768100200QFORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J768200100PTOBRAMYCIN, UNIT DOSE FORM, 300 MG, INHALATION SOLUTION, ADMINISTERED THROUGH   Tobramycin inhalation sol   51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J768200200QDME                                                                                                                                                                                                                                                                                                                  
J768300100PTRIAMCINOLONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, Triamcinolone inh sol con   51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J768300200QPER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J768400100PTRIAMCINOLONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,    Triamcinolone inh sol u d   51      A                  2100.5                                                                             D                          D1G 1P      2000010120020701        N                           
J768400200QPER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J769900100PNOC DRUGS, INHALATION SOLUTION ADMINISTERED THROUGH DME                         Inhalation solution for DME 51      A                  2100.5                                                                             D                          D1G 1P      1993010120020701        N                           
J779900100PNOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME                Non-inhalation drug for DME 51      A                  2100.5                                                                             D                          D1G 1P      1993010120020701        N                           
J849800100PANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED                    Antiemetic rectal/supp NOS  51      A                                          1861s2T                                                    D                          O1D 1       2006010120060101        A                           
J849900100PPRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS                              Oral prescrip drug non chemo00      9                  2049                                                                               M                          O1E 1P      1995010119970101        N                           
J850100100PAPREPITANT, ORAL, 5 MG                                                          Oral aprepitant             51      A                                                                                                     D                      0119O1E 1G      2005010120050101        N                           
J851000100PBUSULFAN; ORAL, 2 MG                                                            Oral busulfan               51      A                  2049.5                                                                             D                          O1D 1P      2000010120000101        N                           
J851500100PCABERGOLINE, ORAL, 0.25 MG                                                      Cabergoline, oral 0.25mg    00      9                  2049.5                                                                             M                          O1E 1P      2006010120060101        A                           
J852000100PCAPECITABINE, ORAL, 150 MG                                                      Capecitabine, oral, 150 mg  51      A                  2049.5                                                                             D                          O1D 1P      2000010120000101        N                           
J852100100PCAPECITABINE, ORAL, 500 MG                                                      Capecitabine, oral, 500 mg  51      A                  2049.5                                                                             D                          O1D 1P      2000010120000101        N                           
J853000100PCYCLOPHOSPHAMIDE; ORAL, 25 MG                                                   Cyclophosphamide oral 25 MG 51      A                  2049.5                                                                             D                          O1D 1GP     1995010119970831        N                           
J854000100PDEXAMETHASONE, ORAL, 0.25 MG                                                    Oral dexamethasone          51      A                                          1861(s)2T                                                  D                          O1E 1       2006010120060101        A                           
J856000100PETOPOSIDE; ORAL, 50 MG                                                          Etoposide oral 50 MG        51      A                  2049.5                                                                             D                          O1D 1P      1995010119970101        N                           
J856500100PGEFITINIB, ORAL, 250 MG                                                         Gefitinib oral              00      9                                                                                                     I                          O1E 9       2005010120050101        N                           
J859700100PANTIEMETIC DRUG, ORAL, NOT OTHERWISE SPECIFIED                                  Antiemetic drug oral NOS    51      A                                          1861s2T                                                    D                          O1D 1       2006010120060101        A                           
J860000100PMELPHALAN; ORAL, 2 MG                                                           Melphalan oral 2 MG         51      A                  2049.5                                                                             D                          O1D 1P      1995010119970101        N                           
J861000100PMETHOTREXATE; ORAL, 2.5 MG                                                      Methotrexate oral 2.5 MG    51      A                  2049.5                                                                             D                          O1D 1GP     1995010119970831        N                           
J870000100PTEMOZOLOMIDE, ORAL, 5 MG                                                        Temozolomide                51      A                  2049.5C                                                                            D                          O1D 1P      2001010120010101        N                           
J899900100PPRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS                                  Oral prescription drug chemo51      A                  2049.5                                                                             D                          O1D 1P      1995010119970101        N                           
J900000100PDOXORUBICIN HCL, 10 MG                                                          Doxorubic hcl 10 MG vl chemo51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J900100100PDOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG                        Doxorubicin hcl liposome inj51      A                  2049                                                                               D                          O1E 1P      2000010120000101        N                           
J901000100PALEMTUZUMAB, 10 MG                                                              Alemtuzumab injection       51      A                                          1833T                                                      D                          O1E 1P      2003010120030101        N                           
J901500100PALDESLEUKIN, PER SINGLE USE VIAL                                                Aldesleukin/single use vial 51      A                  2049                                                                               D                          O1D 1P      1996010119970101        N                           
J901700100PARSENIC TRIOXIDE, 1MG                                                           Arsenic trioxide            51      A                                                                                                     C                          O1D 1P      2002010120020101        N                           
J902000100PASPARAGINASE, 10,000 UNITS                                                      Asparaginase injection      51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J902500100PINJECTION, AZACITIDINE, 1 MG                                                    Azacitidine injection       51      A                                                                                                     C                          O1D 1P      2006010120060101        A                           
J902700100PINJECTION, CLOFARABINE, 1 MG                                                    Clofarabine injection       51      A                                                                                                     C                          O1E 1P      2006010120060101        A                           
J903100100PBCG (INTRAVESICAL) PER INSTILLATION                                             Bcg live intravesical vac   51      A                  2049                                                                               D                          O1D 1P      1991010119970101        N                           
J903500100PINJECTION, BEVACIZUMAB, 10 MG                                                   Bevacizumab injection       51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J904000100PBLEOMYCIN SULFATE, 15 UNITS                                                     Bleomycin sulfate injection 51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J904100100PINJECTION, BORTEZOMIB, 0.1 MG                                                   Bortezomib injection        51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J904500100PCARBOPLATIN, 50 MG                                                              Carboplatin injection       51      A                  2049                                                                               D                          O1D 1P      1990010119970101        N                           
J905000100PCARMUSTINE, 100 MG                                                              Carmus bischl nitro inj     51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J905500100PINJECTION, CETUXIMAB, 10 MG                                                     Cetuximab injection         51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J906000100PCISPLATIN, POWDER OR S0LUTION, PER 10 MG                                        Cisplatin 10 MG injection   51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J906200100PCISPLATIN, 50 MG                                                                Cisplatin 50 MG injection   51      A                  2049                                                                               D                          O1D 1P      1982010119970101        N                           
J906500100PINJECTION, CLADRIBINE, PER 1 MG                                                 Inj cladribine per 1 MG     51      A                  2049                                                                               D                          O1D 1P      1995010119970101        N                           
J907000100PCYCLOPHOSPHAMIDE, 100 MG                                                        Cyclophosphamide 100 MG inj 51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J908000100PCYCLOPHOSPHAMIDE, 200 MG                                                        Cyclophosphamide 200 MG inj 51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J909000100PCYCLOPHOSPHAMIDE, 500 MG                                                        Cyclophosphamide 500 MG inj 51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J909100100PCYCLOPHOSPHAMIDE, 1.0 GRAM                                                      Cyclophosphamide 1.0 grm inj51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J909200100PCYCLOPHOSPHAMIDE, 2.0 GRAM                                                      Cyclophosphamide 2.0 grm inj51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J909300100PCYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG                                           Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P      1988010119970101        N                           
J909400100PCYCLOPHOSPHAMIDE, LYOPHILIZED, 200 MG                                           Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J909500100PCYCLOPHOSPHAMIDE, LYOPHILIZED, 500 MG                                           Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J909600100PCYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM                                         Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J909700100PCYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM                                         Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J909800100PCYTARABINE LIPOSOME, 10 MG                                                      Cytarabine liposome         51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J910000100PCYTARABINE, 100 MG                                                              Cytarabine hcl 100 MG inj   51      A                  2049                                                                               D                          O1D 1P      1986010119970101        N                           
J911000100PCYTARABINE, 500 MG                                                              Cytarabine hcl 500 MG inj   51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J912000100PDACTINOMYCIN, 0.5 MG                                                            Dactinomycin actinomycin d  51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J913000100PDACARBAZINE, 100 MG                                                             Dacarbazine 100 mg inj      51      A                  2049                                                                               D                          O1D 1P      1986010120040101        N                           
J914000100PDACARBAZINE, 200 MG                                                             Dacarbazine 200 MG inj      51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J915000100PDAUNORUBICIN, 10 MG                                                             Daunorubicin                51      A                  2049                                                                               D                          O1D 1P      1986010119980101        N                           
J915100100PDAUNORUBICIN CITRATE, LIPOSOMAL FORMULATION, 10 MG                              Daunorubicin citrate liposom51      A                  2049                                                                               D                          O1D 1P      1999010119990101        N                           
J916000100PDENILEUKIN DIFTITOX, 300 MCG                                                    Denileukin diftitox, 300 mcg51      A                                                                                                     C                          O1E 1P      2001010120010101        N                           
J916500100PDIETHYLSTILBESTROL DIPHOSPHATE, 250 MG                                          Diethylstilbestrol injection51      A                  2049                                                                               D                          O1D 1P      1988010119970101        N                           
J917000100PDOCETAXEL, 20 MG                                                                Docetaxel                   51      A                  2049                                                                               D                          O1D 1P      1998010119980101        N                           
J917500100PINJECTION, ELLIOTTS' B SOLUTION, 1 ML                                           Elliotts b solution per ml  51      A                  2049                                                                               D                      0095O1E 1P      2006010120060101        A                           
J917800100PINJECTION, EPIRUBICIN HCL, 2 MG                                                 Inj, epirubicin hcl, 2 mg   51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J918000100PEPIRUBICIN HYDROCHLORIDE, 50 MG                                                 Epirubicin HCl injection    51      A                  2049                                                                               D                          O1D 1P      200101012004010120031231N                           
J918100100PETOPOSIDE, 10 MG                                                                Etoposide 10 MG inj         51      A                  2049                                                                               D                          O1D 1P      1987010119970101        N                           
J918200100PETOPOSIDE, 100 MG                                                               Etoposide 100 MG inj        51      A                  2049                                                                               D                          O1D 1P      1987010119970101        N                           
J918500100PFLUDARABINE PHOSPHATE, 50 MG                                                    Fludarabine phosphate inj   51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J919000100PFLUOROURACIL, 500 MG                                                            Fluorouracil injection      51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J920000100PFLOXURIDINE, 500 MG                                                             Floxuridine injection       51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J920100100PGEMCITABINE HCL, 200 MG                                                         Gemcitabine HCl             51      A                  2049                                                                               D                          O1D 1P      1998010119980101        N                           
J920200100PGOSERELIN ACETATE IMPLANT, PER 3.6 MG                                           Goserelin acetate implant   51      A                  2049                                                                               D                          O1D 1P      1991010119970101        N                           
J920600100PIRINOTECAN, 20 MG                                                               Irinotecan injection        51      A                  2049                                                                               D                          O1D 1P      1998010119980101        N                           
J920800100PIFOSFAMIDE, 1 GM                                                                Ifosfomide injection        51      A                  2049                                                                               D                          O1D 1P      1990010119970101        N                           
J920900100PMESNA, 200 MG                                                                   Mesna injection             51      A                  2049                                                                               D                          O1D 1P      1990010119970101        N                           
J921100100PIDARUBICIN HYDROCHLORIDE, 5 MG                                                  Idarubicin hcl injection    51      A                  2049                                                                               D                          O1D 1P      1993010119970101        N                           
J921200100PINJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MCG                             Interferon alfacon-1        51      A                  2049                                                                               D                          O1E 1P      1999010119990101        N                           
J921300100PINTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS                               Interferon alfa-2a inj      51      A                  2049                                                                               D                          O1D G       1993010119970101        N                           
J921400100PINTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS                               Interferon alfa-2b inj      51      A                  2049                                                                               D                          O1D G       1993010119970101        N                           
J921500100PINTERFERON, ALFA-N3, (HUMAN LEUKOCYTE DERIVED), 250,000 IU                      Interferon alfa-n3 inj      51      A                  2049                                                                               D                          O1D G       1993010119970101        N                           
J921600100PINTERFERON, GAMMA 1-B, 3 MILLION UNITS                                          Interferon gamma 1-b inj    51      A                  2049                                                                               D                          O1D G       1993010119970101        N                           
J921700100PLEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG                               Leuprolide acetate suspnsion51      A                  2049                                                                               D                          O1D 1P      1991010119970101        N                           
J921800100PLEUPROLIDE ACETATE, PER 1 MG                                                    Leuprolide acetate injeciton51      A                  2049                                                                               D                      0014O1D 1P      1990010119970101        N                           
J921900100PLEUPROLIDE ACETATE IMPLANT, 65 MG                                               Leuprolide acetate implant  51      A                  2049                                                                               D                          O1D 1P      2001010120010101        N                           
J922500100PHISTRELIN IMPLANT, 50 MG                                                        Histrelin implant           51      A                  2049                                                                               D                          O1D 1P      2006010120060101        A                           
J923000100PMECHLORETHAMINE HYDROCHLORIDE, (NITROGEN MUSTARD), 10 MG                        Mechlorethamine hcl inj     51      A                  2049                                                                               D                          O1D 1P      1986010119970101        N                           
J924500100PINJECTION, MELPHALAN HYDROCHLORIDE, 50 MG                                       Inj melphalan hydrochl 50 MG51      A                  2049                                                                               D                          O1D 1P      1995010119970101        N                           
J925000100PMETHOTREXATE SODIUM, 5 MG                                                       Methotrexate sodium inj     51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J926000100PMETHOTREXATE SODIUM, 50 MG                                                      Methotrexate sodium inj     51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J926300100PINJECTION, OXALIPLATIN, 0.5 MG                                                  Oxaliplatin                 51      A                                                                                                     C                          O1D 1P      2004010120040101        N                           
J926400100PINJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG                             Paclitaxel injection        51      A                                                                                                     C                          O1E 1P      2006010120060101        A                           
J926500100PPACLITAXEL, 30 MG                                                               Paclitaxel injection        51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J926600100PPEGASPARGASE, PER SINGLE DOSE VIAL                                              Pegaspargase/singl dose vial51      A                  2049                                                                               D                          O1D 1P      1996010119970101        N                           
J926800100PPENTOSTATIN, PER 10 MG                                                          Pentostatin injection       51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J927000100PPLICAMYCIN, 2.5 MG                                                              Plicamycin (mithramycin) inj51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J928000100PMITOMYCIN, 5 MG                                                                 Mitomycin 5 MG inj          51      A                  2049                                                                               D                          O1D 1P      1986010119970101        N                           
J929000100PMITOMYCIN, 20 MG                                                                Mitomycin 20 MG inj         51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J929100100PMITOMYCIN, 40 MG                                                                Mitomycin 40 MG inj         51      A                  2049                                                                               D                          O1D 1P      1989010119970101        N                           
J929300100PINJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG                                 Mitoxantrone hydrochl / 5 MG51      A                  2049                                                                               D                          O1D 1P      1990010119970101        N                           
J930000100PGEMTUZUMAB OZOGAMICIN, 5MG                                                      Gemtuzumab ozogamicin       51      A                                                                                                     C                          O1D 1P      2002010120020101        N                           
J930500100PINJECTION, PEMETREXED, 10 MG                                                    Pemetrexed injection        51      A                                                                                                     C                          O1E 1P      2005010120050101        N                           
J931000100PRITUXIMAB, 100 MG                                                               Rituximab cancer treatment  51      A                  2049                                                                               D                          O1D 1P      1999010119990101        N                           
J932000100PSTREPTOZOCIN, 1 GM                                                              Streptozocin injection      51      A                  2049                                                                               D                          O1D 1P      1986010119970101        N                           
J934000100PTHIOTEPA, 15 MG                                                                 Thiotepa injection          51      A                  2049                                                                               D                          O1D 1P      1984010119970101        N                           
J935000100PTOPOTECAN, 4 MG                                                                 Topotecan                   51      A                  2049                                                                               D                          O1D 1P      1998010119980101        N                           
J935500100PTRASTUZUMAB, 10 MG                                                              Trastuzumab                 51      A                                                                                                     C                          O1E 1P      2000010120000101        N                           
J935700100PVALRUBICIN, INTRAVESICAL, 200 MG                                                Valrubicin, 200 mg          51      A                  2049                                                                               D                          O1E 1P      2000010120000101        N                           
J936000100PVINBLASTINE SULFATE, 1 MG                                                       Vinblastine sulfate inj     51      A                  2049                                                                               D                          O1D 1P      1986010119970101        N                           
J937000100PVINCRISTINE SULFATE, 1 MG                                                       Vincristine sulfate 1 MG inj51      A                  2049                                                                               D                          O1D 1P      1986010119970101        N                           
J937500100PVINCRISTINE SULFATE, 2 MG                                                       Vincristine sulfate 2 MG inj51      A                  2049                                                                               D                          O1D 1P      1988010119970101        N                           
J938000100PVINCRISTINE SULFATE, 5 MG                                                       Vincristine sulfate 5 MG inj51      A                  2049                                                                               D                          O1D 1P      1994010119970101        N                           
J939000100PVINORELBINE TARTRATE, PER 10 MG                                                 Vinorelbine tartrate/10 mg  51      A                  2049                                                                               D                          O1D 1P      1996010119970101        N                           
J939500100PINJECTION, FULVESTRANT, 25 MG                                                   Injection, Fulvestrant      51      A                                                                                                     C                          O1E 1P      2004010120040101        N                           
J960000100PPORFIMER SODIUM, 75 MG                                                          Porfimer sodium             51      A                  2049                                                                               D                          O1D 1P      1998010119980101        N                           
J999900100PNOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS                                  Chemotherapy drug           51      A45-16             2049                                                                               D                          O1D 1P      1986010119970101        N                           
K000100100PSTANDARD WHEELCHAIR                                                             Standard wheelchair         36      A                                                                                                     C                          D1D R       1994010119940101        N                           
K000200100PSTANDARD HEMI (LOW SEAT) WHEELCHAIR                                             Stnd hemi (low seat) whlchr 36      A                                                                                                     C                          D1D R       1994010119940101        N                           
K000300100PLIGHTWEIGHT WHEELCHAIR                                                          Lightweight wheelchair      36      A                                                                                                     C                          D1D R       1994010119940101        N                           
K000400100PHIGH STRENGTH, LIGHTWEIGHT WHEELCHAIR                                           High strength ltwt whlchr   36      A                                                                                                     C                          D1D R       1994010119940101        N                           
K000500100PULTRALIGHTWEIGHT WHEELCHAIR                                                     Ultralightweight wheelchair 32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K000600100PHEAVY DUTY WHEELCHAIR                                                           Heavy duty wheelchair       36      A                                                                                                     C                          D1D R       1994010119940101        N                           
K000700100PEXTRA HEAVY DUTY WHEELCHAIR                                                     Extra heavy duty wheelchair 36      A                                                                                                     C                          D1D R       1994010119940101        N                           
K000900100POTHER MANUAL WHEELCHAIR/BASE                                                    Other manual wheelchair/base46      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K001000100PSTANDARD - WEIGHT FRAME MOTORIZED/POWER WHEELCHAIR                              Stnd wt frame power whlchr  36      A                                                                                                     C                          D1D APR     1994010119970505        N                           
K001100100PSTANDARD - WEIGHT FRAME MOTORIZED/POWER WHEELCHAIR WITH PROGRAMMABLE CONTROL    Stnd wt pwr whlchr w control36      A                                                                                                     C                          D1D APR     1994010119970505        N                           
K001100200QPARAMETERS FOR SPEED ADJUSTMENT, TREMOR DAMPENING, ACCELERATION CONTROL AND                                                                                                                                                                                                                                          
K001100300QBRAKING                                                                                                                                                                                                                                                                                                              
K001200100PLIGHTWEIGHT PORTABLE MOTORIZED/POWER WHEELCHAIR                                 Ltwt portbl power whlchr    36      A                                                                                                     C                          D1D APR     1994010119970505        N                           
K001400100POTHER MOTORIZED/POWER WHEELCHAIR BASE                                           Other power whlchr base     36      A                                                                                                     C                          D1D APR     1994010120010101        N                           
K001500100PDETACHABLE, NON-ADJUSTABLE HEIGHT ARMREST, EACH                                 Detach non-adjus hght armrst32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K001600100PDETACHABLE, ADJUSTABLE HEIGHT ARMREST, COMPLETE ASSEMBLY, EACH                  Detach adjust armrst cmplete32      A                                                                            E0973                    C                          D1D APR     199401012004010120031231N                           
K001700100PDETACHABLE, ADJUSTABLE HEIGHT ARMREST, BASE, EACH                               Detach adjust armrest base  32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K001800100PDETACHABLE, ADJUSTABLE HEIGHT ARMREST, UPPER PORTION, EACH                      Detach adjust armrst upper  32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K001900100PARM PAD, EACH                                                                   Arm pad each                32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K002000100PFIXED, ADJUSTABLE HEIGHT ARMREST, PAIR                                          Fixed adjust armrest pair   32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K002100100PANTI-TIPPING DEVICE, EACH                                                       Anti-tipping device each    32      A                                                                            E0971                    C                          D1D APR     199401012003010120021231N                           
K002200100PREINFORCED BACK UPHOLSTERY                                                      Reinforced back upholstery  32      A                                                                            E0982                    C                          D1D APR     199401012004010120031231N                           
K002300100PSOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, ATTACHED WITH STRAPS       Planr back insrt foam w/strp32      A                                                                                                     C                          D1D APR     199401012005010120041231N                           
K002400100PSOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, WITH ADJUSTABLE HOOK-ON    Plnr back insrt foam w/hrdwr32      A                                                                                                     C                          D1D APR     199401012005010120041231N                           
K002400200QHARDWARE                                                                                                                                                                                                                                                                                                             
K002500100PHOOK-ON HEADREST EXTENSION                                                      Hook-on headrest extension  32      A                                                                            E0966                    C                          D1D APR     199401012004010120031231N                           
K002600100PBACK UPHOLSTERY FOR ULTRALIGHTWEIGHT OR HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR    Back upholst lgtwt whlchr   32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K002700100PBACK UPHOLSTERY FOR WHEELCHAIR TYPE OTHER THAN ULTRALIGHTWEIGHT OR HIGH         Back upholst other whlchr   32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K002700200QSTRENGTH LIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                                      
K002800100PMANUAL, FULLY RECLINING BACK                                                    Manual fully reclining back 32      A                                                                            E1226                    C                          D1D APR     199401012004010120031231N                           
K002900100PREINFORCED SEAT UPHOLSTERY                                                      Reinforced seat upholstery  32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K003000100PSOLID SEAT INSERT, PLANAR SEAT, SINGLE DENSITY FOAM                             Solid plnr seat sngl dnsfoam32      A                                                                            E0992                    C                          D1D APR     199401012004010120031231N                           
K003100100PSAFETY BELT/PELVIC STRAP, EACH                                                  Safety belt/pelvic strap    32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K003200100PSEAT UPHOLSTERY FOR ULTRALIGHTWEIGHT OR HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR    Seat uphols lgtwt whlchr    32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K003300100PSEAT UPHOLSTERY FOR WHEELCHAIR TYPE OTHER THAN ULTRALIGHTWEIGHT OR HIGH         Seat upholstery other whlchr32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K003300200QSTRENGTH LIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                                      
K003400100PHEEL LOOP,EACH                                                                  Heel loop each              32      A                                                                            E0951                    C                          D1D APR     199401012003010120021231N                           
K003500100PHEEL LOOP WITH ANKLE STRAP, EACH                                                Heel loop with ankle strap  32      A                                                                            E0951                    C                          D1D APR     199401012004010120031231N                           
K003600100PTOE LOOP, EACH                                                                  Toe loop each               32      A                                                                            E0952                    C                          D1D APR     199401012004010120031231N                           
K003700100PHIGH MOUNT FLIP-UP FOOTREST, EACH                                               High mount flip-up footrest 32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K003800100PLEG STRAP, EACH                                                                 Leg strap each              32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K003900100PLEG STRAP, H STYLE, EACH                                                        Leg strap h style each      32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K004000100PADJUSTABLE ANGLE FOOTPLATE, EACH                                                Adjustable angle footplate  32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K004100100PLARGE SIZE FOOTPLATE, EACH                                                      Large size footplate each   32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K004200100PSTANDARD SIZE FOOTPLATE, EACH                                                   Standard size footplate each32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K004300100PFOOTREST, LOWER EXTENSION TUBE, EACH                                            Ftrst lower extension tube  32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K004400100PFOOTREST, UPPER HANGER BRACKET, EACH                                            Ftrst upper hanger bracket  32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K004500100PFOOTREST, COMPLETE ASSEMBLY                                                     Footrest complete assembly  32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K004600100PELEVATING LEGREST, LOWER EXTENSION TUBE, EACH                                   Elevat legrst low extension 32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K004700100PELEVATING LEGREST, UPPER HANGER BRACKET, EACH                                   Elevat legrst up hangr brack32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K004800100PELEVATING LEGREST, COMPLETE ASSEMBLY                                            Elevate legrest complete    32      A                                                                            E0990                    C                          D1D APR     199401012004010120031231N                           
K004900100PCALF PAD, EACH                                                                  Calf pad each               32      A                                                                            E0995                    C                          D1D APR     199401012004010120031231N                           
K005000100PRATCHET ASSEMBLY                                                                Ratchet assembly            32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K005100100PCAM RELEASE ASSEMBLY, FOOTREST OR LEGREST, EACH                                 Cam relese assem ftrst/lgrst32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K005200100PSWINGAWAY, DETACHABLE FOOTRESTS, EACH                                           Swingaway detach footrest   32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K005300100PELEVATING FOOTRESTS, ARTICULATING (TELESCOPING), EACH                           Elevate footrest articulate 32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K005400100PSEAT WIDTH OF 10", 11", 12", 15", 17", OR 20" FOR A HIGH STRENGTH, LIGHTWEIGHT  Seat wdth 10-12/15/17/20 wc 32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K005400200QOR ULTRALIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                                       
K005500100PSEAT DEPTH OF 15", 17", OR 18" FOR A HIGH STRENGTH, LIGHTWEIGHT OR              Seat dpth 15/17/18 ltwt wc  32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K005500200QULTRALIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                                          
K005600100PSEAT HEIGHT LESS THAN  17" OR EQUAL TO  OR GREATER THAN 21" FOR A HIGH          Seat ht <17 or >=21 ltwt wc 32      A                                                                                                     C                          D1D APR     1994010119990101        N                           
K005600200QSTRENGTH, LIGHTWEIGHT, OR ULTRALIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                
K005700100PSEAT WIDTH 19" OR 20" FOR HEAVY DUTY OR EXTRA HEAVY DUTY CHAIR                  Seat wdth 19/20 hvy dty wc  32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K005800100PSEAT DEPTH 17" OR 18" FOR MOTORIZED/POWER WHEELCHAIR                            Seat dpth 17/18 power wc    32      A                                                                                                     C                          D1D APR     199401012004010120031231N                           
K005900100PPLASTIC COATED HANDRIM, EACH                                                    Plastic coated handrim each 32      A                                                                                                     C                          D1D APR     199401012005010120041231N                           
K006000100PSTEEL HANDRIM, EACH                                                             Steel handrim each          32      A                                                                                                     C                          D1D APR     199401012005010120041231N                           
K006100100PALUMINUM HANDRIM, EACH                                                          Aluminum handrim each       32      A                                                                                                     C                          D1D APR     199401012005010120041231N                           
K006200100PHANDRIM WITH 8-10 VERTICAL OR OBLIQUE PROJECTIONS, EACH                         Handrim 8-10 vert/obliq proj32      A                                                                            E0967                    C                          D1D APR     199401012004010120031231N                           
K006300100PHANDRIM WITH 12-16 VERTICAL OR OLBIQUE PROJECTIONS, EACH                        Hndrm 12-16 vert/obliq proj 32      A                                                                            E0967                    C                          D1D APR     199401012004010120031231N                           
K006400100PZERO PRESSURE TUBE (FLAT FREE INSERTS), ANY SIZE, EACH                          Zero pressure tube flat free32      A                                                                            E2213                    C                          D1D APR     199401012006010120051231D                           
K006500100PSPOKE PROTECTORS, EACH                                                          Spoke protectors            32      A                                                                                                     C                          D1D APR     1994010120000101        N                           
K006600100PSOLID TIRE, ANY SIZE, EACH                                                      Solid tire any size each    32      A                                                                            E2220                    C                          D1D APR     199401012006010120051231D                           
K006700100PPNEUMATIC TIRE, ANY SIZE, EACH                                                  Pneumatic tire any size each32      A                                                                            E2211                    C                          D1D APR     199401012006010120051231D                           
K006800100PPNEUMATIC TIRE TUBE, EACH                                                       Pneumatic tire tube each    32      A                                                                            E2212                    C                          D1D APR     199401012006010120051231D                           
K006900100PREAR WHEEL ASSEMBLY, COMPLETE, WITH SOLID TIRE, SPOKES OR MOLDED, EACH          Rear whl complete solid tire32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K007000100PREAR WHEEL ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, SPOKES OR MOLDED, EACH      Rear whl compl pneum tire   32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K007100100PFRONT CASTER ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, EACH                      Front castr compl pneum tire32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K007200100PFRONT CASTER ASSEMBLY, COMPLETE, WITH SEMI-PNEUMATIC TIRE, EACH                 Frnt cstr cmpl sem-pneum tir32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K007300100PCASTER PIN LOCK,EACH                                                            Caster pin lock each        32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K007400100PPNEUMATIC CASTER TIRE, ANY SIZE, EACH                                           Pneumatic caster tire each  32      A                                                                            E2214                    C                          D1D APR     199401012006010120051231D                           
K007500100PSEMI-PNEUMATIC CASTER TIRE, ANY SIZE, EACH                                      Semi-pneumatic caster tire  32      A                                                                            E2219                    C                          D1D APR     199401012006010120051231D                           
K007600100PSOLID CASTER TIRE, ANY SIZE, EACH                                               Solid caster tire each      32      A                                                                            E2221                    C                          D1D APR     199401012006010120051231D                           
K007700100PFRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, EACH                          Front caster assem complete 32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K007800100PPNEUMATIC CASTER TIRE TUBE, EACH                                                Pneumatic caster tire tube  32      A                                                                            E2215                    C                          D1D APR     199401012006010120051231D                           
K007900100PWHEEL LOCK EXTENSION, PAIR                                                      Wheel lock extension pair   32      A                                                                            E0961                    C                          D1D APR     199401012004010120031231N                           
K008000100PANTI-ROLLBACK DEVICE, PAIR                                                      Anti-rollback device pair   32      A                                                                            E0974                    C                          D1D APR     199401012004010120031231N                           
K008100100PWHEEL LOCK ASSEMBLY, COMPLETE, EACH                                             Wheel lock assembly complete32      A                                                                            E2206                    C                          D1D APR     199401012005010120041231N                           
K008200100P22 NF NON-SEALED LEAD ACID BATTERY, EACH                                        22 nf nonsealed leadacid    32      A                                                                            E2360                    C                          D1D APR     199401012004010120031231N                           
K008300100P22 NF SEALED LEAD ACID BATTERY, EACH (E.G., GEL CELL, ABSORBED GLASS MAT)       22nf sealed leadacid battery32      A                                                                            E2361                    C                          D1D APR     199401012004010120031231N                           
K008400100PGROUP 24 NON-SEALED LEAD ACID BATTERY, EACH                                     Gr24 nonsealed leadacid     32      A                                                                            E2362                    C                          D1D APR     199401012004010120031231N                           
K008500100PGROUP 24 SEALED LEAD ACID BATTERY, EACH (E.G., GEL CELL, ABSORBED GLASS MAT)    Gr24 sealed leadacid battery32      A                                                                            E2363                    C                          D1D APR     199401012004010120031231N                           
K008600100PU-1 NON-SEALED LEAD ACID BATTERY, EACH                                          U1nonsealed leadacid battery32      A                                                                            E2364                    C                          D1D APR     199401012004010120031231N                           
K008700100PU-1 SEALED LEAD ACID BATTERY, EACH (E.G., GEL CELL, ABSORBED GLASS MAT)         U1 sealed leadacid battery  32      A                                                                            E2365                    C                          D1D APR     199401012004010120031231N                           
K008800100PBATTERY CHARGER, SINGLE MODE, FOR USE WITH ONLY ONE BATTERY TYPE, SEALED OR     Battery charger, single mode32      A                                                                            E2366                    C                          D1D APR     199401012004010120031231N                           
K008800200QNON-SEALED                                                                                                                                                                                                                                                                                                           
K008900100PBATTERY CHARGER, DUAL MODE, FOR USE WITH EITHER BATTERY TYPE, SEALED OR         Battery charger, dual mode  32      A                                                                            E2367                    C                          D1D APR     199401012004010120031231N                           
K008900200QNON-SEALED                                                                                                                                                                                                                                                                                                           
K009000100PREAR WHEEL TIRE FOR POWER WHEELCHAIR, ANY SIZE, EACH                            Rear tire power wheelchair  32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K009100100PREAR WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR POWER WHEELCHAIR, ANY SIZE,   Rear tire tube power whlchr 32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K009100200QEACH                                                                                                                                                                                                                                                                                                                 
K009200100PREAR WHEEL ASSEMBLY FOR POWER WHEELCHAIR, COMPLETE, EACH                        Rear assem cmplt powr whlchr32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K009300100PREAR WHEEL, ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER WHEELCHAIR,    Rear zero pressure tire tube32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K009300200QANY SIZE, EACH                                                                                                                                                                                                                                                                                                       
K009400100PWHEEL TIRE FOR POWER BASE, ANY SIZE, EACH                                       Wheel tire for power base   32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K009500100PWHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR EACH BASE, ANY SIZE, EACH          Wheel tire tube each base   32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K009600100PWHEEL ASSEMBLY FOR POWER BASE, COMPLETE, EACH                                   Wheel assem powr base complt32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K009700100PWHEEL ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER BASE, ANY SIZE, EACH Wheel zero presure tire tube32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K009800100PDRIVE BELT FOR POWER WHEELCHAIR                                                 Drive belt power wheelchair 32      A                                                                                                     C                          D1D APR     1994010119940101        N                           
K009900100PFRONT CASTER FOR POWER WHEELCHAIR, EACH                                         Pwr wheelchair front  caster32      A                                                                                                     C                          D1D APR     1994010119991001        N                           
K010000100PWHEELCHAIR ADAPTER FOR AMPUTEE, PAIR (DEVICE USED TO COMPENSATE FOR TRANSFER OF Amputee adapter pair        32      A                                                                            E0959                    C                          D1D APR     199401012004010120031231N                           
K010000200QWEIGHT DUE TO LOST LIMBS TO MAINTAIN PROPER BALANCE)                                                                                                                                                                                                                                                                 
K010100100PONE-ARM DRIVE ATTACHMENT, EACH                                                  One-arm drive attachment    36      A                                                                            E0958                    C                          D1D R       199401012003010120021231N                           
K010200100PCRUTCH AND CANE HOLDER, EACH                                                    Crutch and cane holder      32      A                                                                            E2207                    C                          D1D APR     199401012006010120051231D                           
K010300100PTRANSFER BOARD,<25"                                                             Transfer board < 25        32      A                                                                            E0972                    C                          D1D APR     199401012004010120031231N                           
K010400100PCYLINDER TANK CARRIER, EACH                                                     Cylinder tank carrier       32      A                                                                            E2208                    C                          D1D APR     199401012006010120051231D                           
K010500100PIV HANGER, EACH                                                                 Iv hanger                   32      A                                                                                                     C                          D1D APR     1994010120000101        N                           
K010600100PARM TROUGH, EACH                                                                Arm trough each             32      A                                                                            E2209                    C                          D1D APR     199401012006010120051231D                           
K010700100PWHEELCHAIR TRAY                                                                 Wheelchair tray             32      A                                                                            E0950                    C                          D1D APR     199401012004010120031231N                           
K010800100PWHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED                      W/c component-accessory NOS 46      A                                                                                                     C                          D1D APR     1994010119990701        N                           
K011200100PTRUNK SUPPORT DEVICE, VEST TYPE, WITH INNER FRAME, PREFABRICATED                Trunk vest supprt innr frame38      A                                                                                                     C                          D1F P       199401012004010120031231N                           
K011300100PTRUNK SUPPORT DEVICE, VEST TYPE, WITHOUT INNER FRAME, PREFABRICATED             Trunk vest suprt w/o inr frm38      A                                                                                                     C                          D1F P       199401012004010120031231N                           
K011400100PBACK SUPPORT SYSTEM FOR USE WITH A WHEELCHAIR, WITH INNER FRAME, PREFABRICATED  Whlchr back suprt inr frame 32      A                                                                                                     C                          D1D APR     199401012005010120041231N                           
K011500100PSEATING SYSTEM, BACK MODULE, POSTERIORLATERAL CONTROL, WITH OR WITHOUT LATERAL  Back module orthotic system 32      A                                                                                                     C                          D1E APR     199401012005010120041231N                           
K011500200QSUPPORTS, CUSTOM FABRICATED FOR ATTACHMENT TO WHEELCHAIR BASE                                                                                                                                                                                                                                                        
K011600100PSEATING SYSTEM, COMBINED BACK AND SEAT MODULE, CUSTOM FABRICATED FOR ATTACHMENT Back & seat modul orthot sys32      A                                                                                                     C                          D1E APR     199401012005010120041231N                           
K011600200QTO WHEELCHAIR BASE                                                                                                                                                                                                                                                                                                   
K018300100PNASAL APPLICATION DEVICE USED WITH POSITIVE AIRWAY PRESSURE DEVICE              Nasal application device    32      A                                                                            A7034                    C                          D1E APR     199401012003010120021231N                           
K018400100PNASAL SINGLE PIECE INTERFACE, REPLACEMENT FOR NASAL APPLICATION DEVICE, PAIR OR Nasal pillow or face seal   32      A                                                                            A7032A7033               C                          D1E APR     199401012003010120021231N                           
K018400200QSINGLE PIECE INTERFACE                                                                                                                                                                                                                                                                                               
K018500100PHEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE                              Pos airway pressure headgear32      A                                                                            A7035                    C                          D1E APR     199401012003010120021231N                           
K018600100PCHIN STRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE                            Pos airway prssure chinstrap32      A                                                                            A7036                    C                          D1E APR     199401012003010120021231N                           
K018700100PTUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE                                Pos airway pressure tubing  32      A                                                                            A7037                    C                          D1E APR     199401012003010120021231N                           
K018800100PFILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE                   Pos airway pressure filter  32      A                                                                            A7038                    C                          D1E APR     199401012003010120021231N                           
K018900100PFILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE               Filter nondisposable w PAP  32      A                                                                            A7039                    C                          D1E APR     199401012003010120021231N                           
K019500100PELEVATING LEG RESTS, PAIR (FOR USE WITH CAPPED RENTAL WHEELCHAIR BASE)          Elevating whlchair leg rests36      A60-9                                                                                                 D                          D1D R       1993010119930101        N                           
K026800100PHUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE               Humidifier nonheated w PAP  32      A                                                                            E0561                    C                          D1E APR     199301012004010120031231N                           
K041500100PPRESCRIPTION ANTIEMETIC DRUG, ORAL, PER 1 MG, FOR USE IN CONJUNCTION WITH ORAL  RX antiemetic drg, oral NOS 51      A                  2049.5c                                                                            D                          O1D 1       199601012006010120051231D                           
K041500200QANTI-CANCER DRUG, NOT OTHERWISE SPECIFIED                                                                                                                                                                                                                                                                            
K041600100PPRESCRIPTION ANTIEMETIC DRUG, RECTAL, PER 1 MG, FOR USE IN CONJUNCTION WITH     Rx antiemetic drg,rectal NOS51      A                  2049.5c                                                                            D                          O1D 1       199601012006010120051231D                           
K041600200QORAL ANTI-CANCER DRUG, NOT OTHERWISE SPECIFIED                                                                                                                                                                                                                                                                       
K045200100PWHEELCHAIR BEARINGS, ANY TYPE                                                   Wheelchair bearings         32      A                                                                            E2210                    C                          D1D APR     199701012006010120051231D                           
K045500100PINFUSION PUMP USED FOR UNINTERRUPTED PARENTERAL ADMINISTRATION OF MEDICATION,   Pump uninterrupted infusion 31      A60-14                                                                                                D                          D1E R       1998010120030701        N                           
K045500200Q(E.G., EPOPROSTENOL OR TREPROSTINOL)                                                                                                                                                                                                                                                                                 
K046000100PPOWER ADD-ON, TO CONVERT MANUAL WHEELCHAIR TO MOTORIZED WHEELCHAIR, JOYSTICK    WC power add-on joystick    36      A                                                                            E0983                    C                          D1D PR      199807012004010120031231N                           
K046000200QCONTROL                                                                                                                                                                                                                                                                                                              
K046100100PPOWER ADD-ON, TO CONVERT MANUAL WHEELCHAIR TO POWER OPERATED VEHICLE, TILLER    WC power add-on tiller cntrl32      A                                                                            E0984                    C                          D1D PR      199807012004010120031231N                           
K046100200QCONTROL                                                                                                                                                                                                                                                                                                              
K046200100PTEMPORARY REPLACEMENT FOR PATIENT OWNED EQUIPMENT BEING REPAIRED, ANY TYPE      Temporary replacement eqpmnt32      A                  5102.3                                                                             D                          D1E 9       1998070119980701        N                           
K053100100PHUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE                   Heated humidifier used w pap32      A60-9                                                                        E0562                    D                          D1E APR     199910012004010120031231N                           
K053200100PRESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE    Noninvasive assist wo backup36      A60-9                                                                        E0470                    D                          D1E R       199910012004010120031231N                           
K053200200QFEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK                                                                                                                                                                                                                                                 
K053200300Q(INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                         
K053300100PRESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACKUP RATE       Noninvasive assist w backup 31      A60-9                                                                        E0471                    D                          D1E R       199910012004010120031231N                           
K053300200QFEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK                                                                                                                                                                                                                                                 
K053300300Q(INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                         
K053400100PRESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPACITY, WITH BACK UP RATE        Invasive assist w backup    31      A60-9                                                                        E0472                    D                          D1E R       199910012004010120031231N                           
K053400200QFEATURE, USED WITH INVASIVE INTERFACE, E.G., TRACHEOSTOMY TUBE (INTERMITTENT                                                                                                                                                                                                                                         
K053400300QASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                                       
K053800100PNEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE         Neg pressure wnd thrpy pump 36      A                                                                            E2402                    C                          D1E R       200010012004010120031231N                           
K053900100PDRESSING SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR Neg pres wnd thrpy dsg set  34      A                                                                            A6550                    C                          D1E P       200010012004010120031231N                           
K053900200QPORTABLE, EACH                                                                                                                                                                                                                                                                                                       
K054000100PCANISTER SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR Neg pres wnd thrp canister  34      A                                                                            A6551                    C                          D1E P       200010012004010120031231N                           
K054000200QPORTABLE, EACH                                                                                                                                                                                                                                                                                                       
K054100100PSPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES, LESS   SGD prerecorded msg <= 8 min32      A60-23                                                                       E2500                    D                          D1E APR     200101012004010120031231N                           
K054100200QTHAN OR EQUAL TO 8 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                            
K054200100PSPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerecorded msg > 8 min 32      A60-23                                                                                                D                          D1E APR     200101012004010120031231N                           
K054200200QGREATER THAN 8 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                                
K054300100PSPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, REQUIRING MESSAGE FORMULATION BY  SGD msg formed by spelling  32      A60-23                                                                       E2508                    D                          D1E APR     200101012004010120031231N                           
K054300200QSPELLING AND ACCESS BY PHYSICAL CONTACT WITH THE DEVICE                                                                                                                                                                                                                                                              
K054400100PSPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, PERMITTING MULTIPLE METHODS OF    SGD w multi methods msg/accs32      A60-23                                                                       E2510                    D                          D1E APR     200101012004010120031231N                           
K054400200QMESSAGE FORMULATION AND MULTIPLE METHODS OF DEVICE ACCESS                                                                                                                                                                                                                                                            
K054500100PSPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL COMPUTER OR PERSONAL DIGITAL   SGD sftwre prgrm for PC/PDA 32      A60-23                                                                       E2511                    D                          D1E APR     200101012004010120031231N                           
K054500200QASSISTANT                                                                                                                                                                                                                                                                                                            
K054600100PACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING SYSTEM                         SGD accessory,mounting systm32      A60-23                                                                       E2512                    D                          D1E APR     200101012004010120031231N                           
K054700100PACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERWISE CLASSIFIED                SGD accessory NOC           46      A60-23                                                                       E2599                    D                          D1E APR     200101012004010120031231N                           
K054800100PINJECTION, INSULIN LISPRO, UP TO 50 UNITS                                       Insulin lispro              51      A                                                                            J1817                    C                          O1E 1P      200104012003010120021231N                           
K054900100PHOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350     Hosp bed hvy dty xtra wide  36      A60-18                                                                       E0303                    D                          D1B R       200104012004010120031231N                           
K054900200QPOUNDS, BUT LESS THAN OR EQUAL TO 600 POUNDS, WITH ANY TYPE SIDE RAILS, WITH                                                                                                                                                                                                                                         
K054900300QMATTRESS                                                                                                                                                                                                                                                                                                             
K055000100PHOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN   Hosp bed xtra hvy dty x wide36      A60-18                                                                       E0304                    D                          D1B R       200104012004010120031231N                           
K055000200Q600 POUNDS, WITH ANY TYPE SIDE RAILS, WITH MATTRESS                                                                                                                                                                                                                                                                  
K055100100PRESIDUAL LIMB SUPPORT SYSTEM, SOLID BASE WITH ADJUSTABLE DROP HOOKS, MOUNTS TO  Residual limb support system32      A60-6                                                                        E1020                    D                          D1D APR     200107012003010120021231N                           
K055100200QWHEELCHAIR FRAME, EACH                                                                                                                                                                                                                                                                                               
K055200100PSUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH Supply/ext inf pump syr type34      A60-14                                                                                                D                          D1E P       2003070120030701        N                           
K055600100PADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM      Socket insert w lock mech   38      A                                                                            L5673                    C                          D1F P       200210012004010120031231N                           
K055600200QEXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR                                                                                                                                                                                                                                          
K055600300QEQUAL, FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                                
K055700100PADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM      Socket insert w/o lock mech 38      A                                                                            L5679                    C                          D1F P       200210012004010120031231N                           
K055700200QEXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR                                                                                                                                                                                                                                          
K055700300QEQUAL, NOT FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                            
K055800100PADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET    Intl custm cong/atyp insert 38      A                                                                            L5681                    C                          D1F P       200210012004010120031231N                           
K055800200QINSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC                                                                                                                                                                                                                                       
K055800300QOR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER                                                                                                                                                                                                                                         
K055800400QTHAN INITIAL, USE CODE K0556 OR K0557)                                                                                                                                                                                                                                                                               
K055900100PADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET    Initial custom socket insert38      A                                                                            L5683                    C                          D1F P       200210012004010120031231N                           
K055900200QINSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL,                                                                                                                                                                                                                                        
K055900300QELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY                                                                                                                                                                                                                                        
K055900400Q(FOR OTHER THAN INITIAL, USE CODE K0556 OR K0557)                                                                                                                                                                                                                                                                    
K056000100PMETACARPAL PHALANGEAL JOINT REPLACEMENT, TWO PIECES, METAL (E.G., STAINLESS     MCP joint 2-piece for implnt38      A                  2130                                                      L8631                    D                          D1F P       200304012004010120031231N                           
K056000200QSTEEL OR COBALT CHROME), CERAMIC-LIKE MATERIAL (E.G., PYROCARBON), FOR SURGICAL                                                                                                                                                                                                                                      
K056000300QIMPLANTATION (ALL SIZES, INCLUDES ENTIRE SYSTEM)                                                                                                                                                                                                                                                                     
K056100100POSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE                         Nonpectin based ostomy paste37      A                  2130                                                      A4405                    D                          D1A P       200204012003010120021231N                           
K056200100POSTOMY SKIN BARRIER, PECTIN-BASED, PASTE, PER OUNCE                             Pectin based ostomy paste   37      A                  2130                                                      A4406                    D                          D1A P       200204012003010120021231N                           
K056300100POSTOMY SKIN BARRIER WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,  Ext wear ost skn barr <=4sq"37      A                  2130                                                      A4407                    D                          D1A P       200204012003010120021231N                           
K056300200QWITH BUILT-IN CONVEXITY, 4X4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                                 
K056400100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ext wear ost skn barr >4sq" 37      A                  2130                                                      A4408                    D                          D1A P       200204012003010120021231N                           
K056400200QWITH BUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH                                                                                                                                                                                                                                                                
K056500100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barr w flng <=4sq"  37      A                  2130                                                      A4409                    D                          D1A P       200204012003010120021231N                           
K056500200QWITHOUT BUILT-IN CONVEXITY, 4X4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                              
K056600100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barr w flng >4sq"   37      A                  2130                                                      A4410                    D                          D1A P       200204012003010120021231N                           
K056600200QWITHOUT BUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH                                                                                                                                                                                                                                                             
K056700100POSTOMY POUCH, DRAINABLE, WITH KARAYA BASED BARRIER ATTACHED, WITHOUT BUILT-IN   1 pc drainable ost pouch    37      A                  2130                                                                               D                          D1A P       200204012003010120021231N                           
K056700200QCONVEXITY, (1 PIECE), EACH                                                                                                                                                                                                                                                                                           
K056800100POSTOMY POUCH, DRAINABLE, WITH STANDARD WEAR BARRIER ATTACHED, WITHOUT BUILT-IN  1 pc cnvx drainabl ost pouch37      A                  2130                                                                               D                          D1A P       200204012003010120021231N                           
K056800200QCONVEXITY, (1 PIECE), EACH                                                                                                                                                                                                                                                                                           
K056900100POSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON BARRIER WITH FLANGE (2 PIECE   2 pc drainable ost pouch    37      A                  2130                                                      A4413                    D                          D1A P       200204012003010120021231N                           
K056900200QSYSTEM), EACH                                                                                                                                                                                                                                                                                                        
K057000100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT        Ostomy skn barr w flng<=4sq"37      A                  2130                                                      A4414                    D                          D1A P       200204012003010120021231N                           
K057000200QBUILT-IN CONVEXITY, 4X4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                                      
K057100100POSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT        Ostomy skn barr w flng >4sq"37      A                  2130                                                      A4415                    D                          D1A P       200204012003010120021231N                           
K057100200QBUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH                                                                                                                                                                                                                                                                     
K057200100PTAPE, NON-WATERPROOF, PER 18 SQUARE INCHES                                      Non-waterproof tape         37      A                  2130                                                      A4450                    D                          D1A P       200204012003010120021231N                           
K057300100PTAPE, WATERPROOF, PER 18 SQUARE INCHES                                          Waterproof tape             37      A                  2130                                                      A4452                    D                          D1A P       200204012003010120021231N                           
K057400100PADDITION TO OSTOMY POUCH, FILTER, INTEGRAL OR ADDED SEPARATELY TO POUCH, EACH   Ostomy pouch filter         37      A                  2130                                                                               D                          D1A P       200204012003010120021231N                           
K057500100PADDITION TO OSTOMY POUCH, RUSTLE-FREE MATERIAL, PER POUCH                       Ost pouch rustle free mat   37      A                  2130                                                                               D                          D1A P       200204012003010120021231N                           
K057600100PADDITION TO OSTOMY POUCH, FRICTION AND IRRITANT-REDUCING, ABSORBENT, INTERFACE  Ostomy pouch comfort panel  37      A                  2130                                                                               D                          D1A P       200204012003010120021231N                           
K057600200QLAYER (COMFORT PANEL), PER POUCH                                                                                                                                                                                                                                                                                     
K057700100PADDITION TO OSTOMY POUCH, ODOR BARRIER, INCORPORATED INTO POUCH LAMINATE, PER   Ostomy pouch odor barrier   37      A                  2130                                                                               D                          D1A P       200204012003010120021231N                           
K057700200QPOUCH                                                                                                                                                                                                                                                                                                                
K057800100PADDITION TO OSTOMY POUCH, FAUCET-TYPE TAP WITH VALVE FOR DRAINING URINARY       Urinary pouch faucet/drain  37      A                  2130                                                                               D                          D1A P       200204012003010120021231N                           
K057800200QPOUCH, EACH                                                                                                                                                                                                                                                                                                          
K057900100PADDITION TO OSTOMY POUCH, ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKET) TO      Ost pouch absorbent material37      A                  2130                                                      A4422                    D                          D1A P       200204012003010120021231N                           
K057900200QTHICKEN LIQUID STOMAL OUTPUT, FOR USE IN POUCH, EACH                                                                                                                                                                                                                                                                 
K058000100PADDITION TO OSTOMY POUCH, FLANGE LOCKING                                        Ost pouch locking flange    37      A                  2130                                                                               D                          D1A P       200204012003010120021231N                           
K058100100POSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH        Ost pch clsd w barrier/filtr37      A                                                                            A4416                    C                          D1F P       200301012004010120031231N                           
K058200100POSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH      Ost pch w bar/bltinconv/fltr37      A                                                                            A4417                    C                          D1F P       200301012004010120031231N                           
K058200200QFILTER (1 PIECE), EACH                                                                                                                                                                                                                                                                                               
K058300100POSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH     Ost pch clsd w/o bar w filtr37      A                                                                            A4418                    C                          D1F P       200301012004010120031231N                           
K058400100POSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLANGE, WITH FILTER (2 PIECE),    Ost pch for bar w flange/flt37      A                                                                            A4419                    C                          D1F P       200301012004010120031231N                           
K058400200QEACH                                                                                                                                                                                                                                                                                                                 
K058500100POSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH    Ost pch clsd for bar w lk fl37      A                                                                            A4420                    C                          D1F P       200301012004010120031231N                           
K058600100POSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2    Ost pch for bar w lk fl/fltr37      A                                                                            A4423                    C                          D1F P       200301012004010120031231N                           
K058600200QPIECE), EACH                                                                                                                                                                                                                                                                                                         
K058700100POSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH     Ost pch drain w bar & filter37      A                                                                            A4424                    C                          D1F P       200301012004010120031231N                           
K058800100POSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH FLANGE, WITH FILTER (2 PIECE   Ost pch drain for barrier fl37      A                                                                            A4425                    C                          D1F P       200301012004010120031231N                           
K058800200QSYSTEM), EACH                                                                                                                                                                                                                                                                                                        
K058900100POSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE        Ost pch drain 2 piece system37      A                                                                            A4426                    C                          D1F P       200301012004010120031231N                           
K058900200QSYSTEM), EACH                                                                                                                                                                                                                                                                                                        
K059000100POSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2 Ost pch drain/barr lk flng/f37      A                                                                            A4427                    C                          D1F P       200301012004010120031231N                           
K059000200QPIECE SYSTEM), EACH                                                                                                                                                                                                                                                                                                  
K059100100POSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FAUCET-TYPE    Urine ost pouch w faucet/tap37      A                                                                            A4428                    C                          D1F P       200301012004010120031231N                           
K059100200QTAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                                                       
K059200100POSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH     Urine ost pouch w bltinconv 37      A                                                                            A4429                    C                          D1F P       200301012004010120031231N                           
K059200200QFAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                                           
K059300100POSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN       Ost urine pch w b/bltin conv37      A                                                                            A4430                    C                          D1F P       200301012004010120031231N                           
K059300200QCONVEXITY, WITH FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                           
K059400100POSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH VALVE   Ost pch urine w barrier/tapv37      A                                                                            A4431                    C                          D1F P       200301012004010120031231N                           
K059400200Q(1 PIECE), EACH                                                                                                                                                                                                                                                                                                      
K059500100POSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE, WITH FAUCET-TYPE TAP     Os pch urine w bar/fange/tap37      A                                                                            A4432                    C                          D1F P       200301012004010120031231N                           
K059500200QWITH VALVE (2 PIECE), EACH                                                                                                                                                                                                                                                                                           
K059600100POSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH   Urine ost pch bar w lock fln37      A                                                                            A4433                    C                          D1F P       200301012004010120031231N                           
K059700100POSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FAUCET-TYPE Ost pch urine w lock flng/ft37      A                                                                            A4434                    C                          D1F P       200301012004010120031231N                           
K059700200QTAP WITH VALVE (2 PIECE), EACH                                                                                                                                                                                                                                                                                       
K060000100PFUNCTIONAL NEUROMUSCULAR STIMULATOR, TRANSCUTANEOUS STIMULATION OF MUSCLES OF   Functional neuromuscularstim32      A35-77                                                                       E0762                    D                          D1E APR     200304012006010120051231D                           
K060000200QAMBULATION WITH COMPUTER CONTROL, USED FOR WALKING BY SPINAL CORD INJURED,                                                                                                                                                                                                                                           
K060000300QENTIRE SYSTEM, AFTER COMPLETION OF TRAINING PROGRAM                                                                                                                                                                                                                                                                  
K060100100PREPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE,  Repl batt silver oxide 1.5 v32      A                                                                                                     C                          D1E APR     2003040120030401        N                           
K060100200Q1.5 VOLT, EACH                                                                                                                                                                                                                                                                                                       
K060200100PREPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE,  Repl batt silver oxide 3 v  32      A                                                                                                     C                          D1E APR     2003040120030401        N                           
K060200200Q3 VOLT, EACH                                                                                                                                                                                                                                                                                                         
K060300100PREPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, ALKALINE, 1.5  Repl batt alkaline 1.5 v    32      A                                                                                                     C                          D1E APR     2003040120030401        N                           
K060300200QVOLT, EACH                                                                                                                                                                                                                                                                                                           
K060400100PREPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 3.6   Repl batt lithium 3.6 v     32      A                                                                                                     C                          D1E APR     2003040120030401        N                           
K060400200QVOLT, EACH                                                                                                                                                                                                                                                                                                           
K060500100PREPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 4.5   Repl batt lithium 4.5 v     32      A                                                                                                     C                          D1E APR     2003040120030401        N                           
K060500200QVOLT, EACH                                                                                                                                                                                                                                                                                                           
K060600100PAUTOMATIC EXTERNAL DEFIBRILLATOR, WITH INTEGRATED ELECTROCARDIOGRAM ANALYSIS,   AED garment w elec analysis 36      A                                                                                                     C                          D1E APR     2003070120030701        N                           
K060600200QGARMENT TYPE                                                                                                                                                                                                                                                                                                         
K060700100PREPLACEMENT BATTERY FOR AUTOMATED EXTERNAL DEFIBRILLATOR, GARMENT TYPE ONLY,    Repl batt for AED           32      A                                                                                                     C                          D1E APR     2003070120030701        N                           
K060700200QEACH                                                                                                                                                                                                                                                                                                                 
K060800100PREPLACEMENT GARMENT FOR USE WITH AUTOMATED EXTERNAL DEFIBRILLATOR, EACH         Repl garment for AED        32      A                                                                                                     C                          D1E APR     2003070120030701        N                           
K060900100PREPLACEMENT ELECTRODES FOR USE WITH AUTOMATED EXTERNAL DEFIBRILLATOR, GARMENT   Repl electrode for AED      34      A                                                                                                     C                          D1E P       2003070120030701        N                           
K060900200QTYPE ONLY, EACH                                                                                                                                                                                                                                                                                                      
K061000100PPERITONEAL DIALYSIS CLAMPS, EACH                                                Peritoneal dialysis clamp   52      A                  4270                                                      E1634                    D                          P9B L       200307012004010120031231N                           
K061100100PDISPOSABLE CYCLER SET USED WITH CYCLER DIALYSIS MACHINE, EACH                   Disposable cycler set       52      A                  4270                                                      A4671                    D                          P9B L       200307012004010120031231N                           
K061200100PDRAINAGE EXTENSION LINE, STERILE, FOR DIALYSIS, EACH                            Drainage ext line, dialysis 52      A                  4270                                                      A4672                    D                          P9B L       200307012004010120031231N                           
K061300100PEXTENSION LINE WITH EASY LOCK CONNECTORS, USED WITH DIALYSIS                    Ext line w easy lock connect52      A                  4270                                                      A4673                    D                          P9B L       200307012004010120031231N                           
K061400100PCHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERILIZE DIALYSIS EQUIPMENT, PER  Chem/antisept solution, 8oz 52      A                  4270                                                      A4674                    D                          P9B L       200307012004010120031231N                           
K061400200Q8 OZ                                                                                                                                                                                                                                                                                                                 
K061500100PSPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec mes >8min <=20min32      A60-23                                                                       E2502                    D                          D1E APR     200307012004010120031231N                           
K061500200QGREATER THAN 8 MINUTES BUT LESS THAN OR EQUAL TO 20 MINUTES RECORDING TIME                                                                                                                                                                                                                                           
K061600100PSPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec mes>20min <=40min32      A60-23                                                                       E2504                    D                          D1E APR     200307012004010120031231N                           
K061600200QGREATER THAN 20 MINUTES BUT LESS THAN OR EQUAL TO 40 MINUTES RECORDING TIME                                                                                                                                                                                                                                          
K061700100PSPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec mes > 40min      32      A60-23                                                                       E2506                    D                          D1E APR     200307012004010120031231N                           
K061700200QGREATER THAN 40 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                               
K061800100PTLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID      TLSO 2 piece rigid shell    38      A                                                                            L0491                    C                          D1F P       200307012006010120051231D                           
K061800200QPLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                               
K061800300QTERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE                                                                                                                                                                                                                                            
K061800400QSYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE                                                                                                                                                                                                                                      
K061800500QSAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                             
K061800600QPLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
K061800700QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K061900100PTLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID    TLSO 3 piece rigid shell    38      A                                                                            L0492                    C                          D1F P       200307012006010120051231D                           
K061900200QPLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                               
K061900300QTERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE                                                                                                                                                                                                                                            
K061900400QSYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE                                                                                                                                                                                                                                      
K061900500QSAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                             
K061900600QPLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
K061900700QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K062000100PTUBULAR ELASTIC DRESSING, ANY WIDTH, PER LINEAR YARD                            Tubular elastic dressing    35      A                                                                            A6457                    C                          D1A S       200307012006010120051231D                           
K062100100PGAUZE, PACKING STRIPS, NON-IMPREGNATED, UP TO 2 INCHES IN WIDTH, PER LINEAR YARDGauze, non-impreg pack strip35      A                                                                                                     C                          D1A S       200307012004010120031231N                           
K062200100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE WIDTH LESS THAN     Confrm band non str <3in/rol35      A                                                                                                     C                          D1A S       200310012004010120031231N                           
K062200200QTHREE INCHES, PER ROLL                                                                                                                                                                                                                                                                                               
K062300100PCONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE WIDTH LESS THAN THREE   Confrm band sterl>3in/roll  35      A                                                                                                     C                          D1A S       200310012004010120031231N                           
K062300200QINCHES, PER ROLL                                                                                                                                                                                                                                                                                                     
K062400100PLIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH LESS THAN 3 INCHES,    Lite compress wdth<3in/roll 35      A                                                                                                     C                          D1A S       200310012004010120031231N                           
K062400200QPER ROLL (AT LEAST 3 YARDS UNSTRETCHED)                                                                                                                                                                                                                                                                              
K062500100PSELF ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, LOAD RESISTANCE GREATER  Self adher wdth <3 in, roll 35      A                                                                                                     C                          D1A S       200310012004010120031231N                           
K062500200QTHAN OR EQUAL TO 0.55 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH LESS THAN 3                                                                                                                                                                                                                                          
K062500300QINCHES, PER ROLL                                                                                                                                                                                                                                                                                                     
K062600100PSELF ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, LOAD RESISTANCE GREATER  Self adher wdth >=5 in, roll35      A                                                                                                     C                          D1A S       200310012004010120031231N                           
K062600200QTHAN OR EQUAL TO 0.55 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR                                                                                                                                                                                                                                      
K062600300QEQUAL TO 5 INCHES, PER ROLL                                                                                                                                                                                                                                                                                          
K062700100PTRACTION EQUIPMENT, CERVICAL, FREE-STANDING, PNEUMATIC, APPLYING TRACTION FORCE Cervical pneum trac equip   32      A                                                                            E0849                    C                          D1E APR     200404012005010120041231N                           
K062700200QTO OTHER THAN MANDIBLE                                                                                                                                                                                                                                                                                               
K062800100PFOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT      Multi den insert direct form52      A                                                                            A5512                    C                          D1F J       200404012006010120051231D                           
K062800200QAFTER EXTERNAL HEAT SOURCE OF 230 DEGREES FAHRENHEIT OR HIGHER, TOTAL CONTACT                                                                                                                                                                                                                                        
K062800300QWITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER MINIMUM OF 1/4 INCH MATERIAL OF                                                                                                                                                                                                                                      
K062800400QSHORE A 35 DUROMETER OR 3/16 INCH MATERIAL OF SHORE A 40 DUROMETER (OR HIGHER),                                                                                                                                                                                                                                      
K062800500QPREFABRICATED, EACH                                                                                                                                                                                                                                                                                                  
K062900100PFOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, CUSTOM MOLDED FROM MODEL OF        Multi den insert custom mold52      A                                                                            A5513                    C                          D1F J       200404012006010120051231D                           
K062900200QPATIENT'S FOOT, TOTAL CONTACT WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER                                                                                                                                                                                                                                        
K062900300QMINIMUM OF 3/16 INCH MATERIAL OF SHORE A 35 DUROMETER OR HIGHER, INCLUDES ARCH                                                                                                                                                                                                                                       
K062900400QFILLER AND OTHER SHAPING MATERIAL, CUSTOM FABRICATED, EACH                                                                                                                                                                                                                                                           
K063000100PSACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION   SIO flex pelvisacral prefab 38      A                                                                            L0621                    C                          D1F P       200404012006010120051231D                           
K063000200QABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS                                                                                                                                                                                                                                         
K063000300QABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
K063100100PSACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION   SIO flex pelvisacral custom 38      A                                                                            L0622                    C                          D1F P       200404012006010120051231D                           
K063100200QABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS                                                                                                                                                                                                                                         
K063100300QABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                    
K063200100PSACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID   SIO panel prefab            38      A                                                                            L0623                    C                          D1F P       200404012006010120051231D                           
K063200200QPANELS OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT,                                                                                                                                                                                                                                       
K063200300QINCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                      
K063200400QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K063300100PSACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID   SIO panel custom            38      A                                                                            L0624                    C                          D1F P       200404012006010120051231D                           
K063300200QPANELS PLACED OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC                                                                                                                                                                                                                                       
K063300300QJOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM                                                                                                                                                                                                                                       
K063300400QFABRICATED                                                                                                                                                                                                                                                                                                           
K063400100PLUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT, POSTERIOR EXTENDS FROM L1   LO flexibl L1-below L5 pre  38      A                                                                            L0625                    C                          D1F P       200404012006010120051231D                           
K063400200QTO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE                                                                                                                                                                                                                                         
K063400300QINTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN                                                                                                                                                                                                                                       
K063400400QDESIGN, SHOULDER STRAPS, STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                       
K063500100PLUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR     LO sag stays/panels pre-fab 38      A                                                                            L0626                    C                          D1F P       200404012006010120051231D                           
K063500200QEXTENDS FROM L1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                            
K063500300QREDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE                                                                                                                                                                                                                                      
K063500400QPADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                            
K063500500QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K063600100PLUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS,    LO sagitt rigid panel prefab38      A                                                                            L0627                    C                          D1F P       200404012006010120051231D                           
K063600200QPOSTERIOR EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                             
K063600300QPRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K063600400QMAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                       
K063600500QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K063700100PLUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR      LO flex w/o rigid stays pre 38      A                                                                            L0628                    C                          D1F P       200404012006010120051231D                           
K063700200QEXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                         
K063700300QPRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K063700400QMAY INCLUDE STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                         
K063700500QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K063800100PLUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR      LSO flex w/rigid stays cust 38      A                                                                            L0629                    C                          D1F P       200404012006010120051231D                           
K063800200QEXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                         
K063800300QPRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K063800400QMAY INCLUDE STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                      
K063900100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S),        LSO post rigid panel pre    38      A                                                                            L0630                    C                          D1F P       200404012006010120051231D                           
K063900200QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES                                                                                                                                                                                                                                             
K063900300QINTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES                                                                                                                                                                                                                                          
K063900400QSTRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS                                                                                                                                                                                                                                             
K063900500QABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
K064000100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR     LSO sag-coro rigid frame pre38      A                                                                            L0631                    C                          D1F P       200404012006010120051231D                           
K064000200QPANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                              
K064000300QPRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,                                                                                                                                                                                                                                          
K064000400QINCLUDES STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                       
K064000500QADJUSTMENT                                                                                                                                                                                                                                                                                                           
K064100100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR     LSO sag-cor rigid frame cust38      A                                                                            L0632                    C                          D1F P       200404012006010120051231D                           
K064100200QPANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                              
K064100300QPRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,                                                                                                                                                                                                                                          
K064100400QINCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS                                                                                                                                                                                                                                           
K064100500QABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                    
K064200100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR          LSO flexion control prefab  38      A                                                                            L0633                    C                          D1F P       200404012006010120051231D                           
K064200200QFRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                      
K064200300QLATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                      
K064200400QPRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
K064200500QINCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                                   
K064200600QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
K064300100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR          LSO flexion control custom  38      A                                                                            L0634                    C                          D1F P       200404012006010120051231D                           
K064300200QFRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                      
K064300300QLATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                      
K064300400QPRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
K064300500QINCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, CUSTOM                                                                                                                                                                                                                                            
K064300600QFABRICATED                                                                                                                                                                                                                                                                                                           
K064400100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID         LSO sagit rigid panel prefab38      A                                                                            L0635                    C                          D1F P       200404012006010120051231D                           
K064400200QPOSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE,                                                                                                                                                                                                                                        
K064400300QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL                                                                                                                                                                                                                                              
K064400400QSTRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                              
K064400500QPRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
K064400600QINCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                            
K064400700QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K064500100PLUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID         LSO sagittal rigid panel cus38      A                                                                            L0636                    C                          D1F P       200404012006010120051231D                           
K064500200QPOSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE,                                                                                                                                                                                                                                        
K064500300QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL                                                                                                                                                                                                                                              
K064500400QSTRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                              
K064500500QPRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
K064500600QINCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                         
K064600100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND       LSO sag-coronal panel prefab38      A                                                                            L0637                    C                          D1F P       200404012006010120051231D                           
K064600200QPOSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9                                                                                                                                                                                                                                        
K064600300QVERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES                                                                                                                                                                                                                                          
K064600400QINTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
K064600500QCLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                            
K064600600QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
K064700100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND       LSO sag-coronal panel custom38      A                                                                            L0638                    C                          D1F P       200404012006010120051231D                           
K064700200QPOSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9                                                                                                                                                                                                                                        
K064700300QVERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES                                                                                                                                                                                                                                          
K064700400QINTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
K064700500QCLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                            
K064700600QCUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
K064800100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S)       LSO s/c shell/panel prefab  38      A                                                                            L0639                    C                          D1F P       200404012006010120051231D                           
K064800200QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                             
K064800300QEXTENDS FROM SYMPHYSIS PUBIS TO XYPHOID, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                          
K064800400QREDUCE LOAD ON THE INTERVERTEBRAL DISCS, OVERALL STRENGTH IS PROVIDED BY                                                                                                                                                                                                                                             
K064800500QOVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K064800600QMAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                        
K064800700QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
K064900100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S),      LSO s/c shell/panel custom  38      A                                                                            L0640                    C                          D1F P       200404012006010120051231D                           
K064900200QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                             
K064900300QEXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                          
K064900400QREDUCE LOAD ON THE INTERVERTEBRAL DISCS, OVERALL STRENGTH IS PROVIDED BY                                                                                                                                                                                                                                             
K064900500QOVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K064900600QMAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                              
K065000100PGENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH       Gen w/c cushion width < 22 32      A                                                                            E2601                    C                          D1D APR     200407012005010120041231N                           
K065100100PGENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH      Gen w/c cushion width > 22 32      A                                                                            E2602                    C                          D1D APR     200407012005010120041231N                           
K065200100PSKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH   Skin pro w/c cus wd < 22   32      A                                                                            E2603                    C                          D1D APR     200407012005010120041231N                           
K065300100PSKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH  Skin protect w/c cus wd>=2232      A                                                                            E2604                    C                          D1D APR     200407012005010120041231N                           
K065400100PPOSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH       Position w/c cush width <2232      A                                                                            E2605                    C                          D1D APR     200407012005010120041231N                           
K065500100PPOSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH      Position w/c cush width >2232      A                                                                            E2606                    C                          D1D APR     200407012005010120041231N                           
K065600100PSKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22     Skin pro/pos w/c cus wd <2232      A                                                                            E2607                    C                          D1D APR     200407012005010120041231N                           
K065600200QINCHES, ANY DEPTH                                                                                                                                                                                                                                                                                                    
K065700100PSKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR     Skin pro/pos w/c cus wd>=2232      A                                                                            E2608                    C                          D1D APR     200407012005010120041231N                           
K065700200QGREATER, ANY DEPTH                                                                                                                                                                                                                                                                                                   
K065800100PCUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE                             Custom fabricate w/c cushion32      A                                                                            E2609                    C                          D1D APR     200407012005010120041231N                           
K065900100PWHEELCHAIR SEAT CUSHION, POWERED                                                Powered w/c cushion         32      A                                                                            E2610                    C                          D1D APR     200407012005010120041231N                           
K066000100PGENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS THAN 22 INCHES, ANY HEIGHT,     Gen use back cush width <2232      A                                                                            E2611                    C                          D1D APR     200407012005010120041231N                           
K066000200QINCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                 
K066100100PGENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCHES OR GREATER, ANY HEIGHT,    Gen use back cush width >2232      A                                                                            E2612                    C                          D1D APR     200407012005010120041231N                           
K066100200QINCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                 
K066200100PPOSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH LESS THAN 22 INCHES, ANY  Position back cush wdth <2232      A                                                                            E2613                    C                          D1D APR     200407012005010120041231N                           
K066200200QHEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                         
K066300100PPOSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH 22 INCHES OR GREATER, ANY Position back cush wdth >2232      A                                                                            E2614                    C                          D1D APR     200407012005010120041231N                           
K066300200QHEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                         
K066400100PPOSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH LESS THAN 22      Pos back post/lat width <2232      A                                                                            E2615                    C                          D1D APR     200407012005010120041231N                           
K066400200QINCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                             
K066500100PPOSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH 22 INCHES OR      Pos back post/lat width >2232      A                                                                            E2616                    C                          D1D APR     200407012005010120041231N                           
K066500200QGREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                            
K066600100PCUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE         Custom fab w/c back cushion 32      A                                                                            E2617                    C                          D1D APR     200407012005010120041231N                           
K066600200QMOUNTING HARDWARE                                                                                                                                                                                                                                                                                                    
K066700100PMOUNTING HARDWARE, ANY TYPE, FOR SEAT CUSHION OR SEAT SUPPORT BASE ATTACHED TO  Mt hardwre man/light pwr w/c32      A                                                                                                     C                          D1D APR     200407012005010120041231N                           
K066700200QA MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, PER CUSHION/BASE                                                                                                                                                                                                                                                
K066800100PREPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR BACK CUSHION, EACH             Replace cover w/c seat cush 32      A                                                                            E2619                    C                          D1D APR     200407012005010120041231N                           
K066900100PWHEELCHAIR ACCESSORY, WHEELCHAIR SEAT OR BACK CUSHION, DOES NOT MEET SPECIFIC   Seat/back cus no sadmerc ver32      A                                                                                                     C                          D1D APR     2004070120060101        C                           
K066900200QCODE CRITERIA OR NO WRITTEN CODING VERIFICATION FROM SADMERC                                                                                                                                                                                                                                                         
K067000100PADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM,          Stance phase only           38      A                                                                            E1392                    C                          D1F P       200504012006010120051231D                           
K067000200QMICROPROCESSOR CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC                                                                                                                                                                                                                                               
K067000300QSENSOR(S), ANY TYPE                                                                                                                                                                                                                                                                                                  
K067100100PPORTABLE OXYGEN CONCENTRATOR, RENTAL                                            Portable oxygen concentrator33      A60-4                                                                        E1392                    D                          D1C R       200504012006010120051231D                           
K073000100PCONTROLLED DOSE INHALATION DRUG DELIVERY SYSTEM                                 Ctrl dose inh drug deliv sys36      A                                                                                                     C                          D1E R       2005070120050701        A                           
K073100100PLITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR,      Lith ion bat CID non-ear lvl38      A                                                                            L8623                    C                          D1F P       200507012006010120051231D                           
K073100200QOTHER THAN EAR LEVEL, REPLACEMENT, EACH                                                                                                                                                                                                                                                                              
K073200100PLITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, EAR  Lith ion batt CID ear level 38      A                                                                            L8624                    C                          D1F P       200507012006010120051231D                           
K073200200QLEVEL, REPLACEMENT, EACH                                                                                                                                                                                                                                                                                             
L010000100PCRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT INTERFACE,  MOLDED TO PATIENT   Cranial orthosis/helmet mold38      A                                                                                                     C                          D1F P       1982010120020101        N                           
L010000200QMODEL                                                                                                                                                                                                                                                                                                                
L011000100PCRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT-INTERFACE, NON-MOLDED           Cranial orthosis/helmet nonm38      A                                                                                                     C                          D1F P       1982010120020101        N                           
L011200100PCRANIAL CERVICAL ORTHOSIS, CONGENITAL TORTICOLLIS TYPE, WITH OR WITHOUT SOFT    Cranial cervical orthosis   38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L011200200QINTERFACE MATERIAL, ADJUSTABLE RANGE OF MOTION JOINT, CUSTOM FABRICATED                                                                                                                                                                                                                                              
L012000100PCERVICAL, FLEXIBLE, NON-ADJUSTABLE (FOAM COLLAR)                                Cerv flexible non-adjustable38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L013000100PCERVICAL, FLEXIBLE, THERMOPLASTIC COLLAR, MOLDED TO PATIENT                     Flex thermoplastic collar mo38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L014000100PCERVICAL, SEMI-RIGID, ADJUSTABLE (PLASTIC COLLAR)                               Cervical semi-rigid adjustab38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L015000100PCERVICAL, SEMI-RIGID, ADJUSTABLE MOLDED CHIN CUP (PLASTIC COLLAR WITH           Cerv semi-rig adj molded chn38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L015000200QMANDIBULAR/OCCIPITAL PIECE)                                                                                                                                                                                                                                                                                          
L016000100PCERVICAL, SEMI-RIGID, WIRE FRAME OCCIPITAL/MANDIBULAR SUPPORT                   Cerv semi-rig wire occ/mand 38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L017000100PCERVICAL, COLLAR, MOLDED TO PATIENT MODEL                                       Cervical collar molded to pt38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L017200100PCERVICAL, COLLAR, SEMI-RIGID THERMOPLASTIC FOAM, TWO PIECE                      Cerv col thermplas foam 2 pi38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L017400100PCERVICAL, COLLAR, SEMI-RIGID, THERMOPLASTIC FOAM, TWO PIECE WITH THORACIC       Cerv col foam 2 piece w thor38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L017400200QEXTENSION                                                                                                                                                                                                                                                                                                            
L018000100PCERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE       Cer post col occ/man sup adj38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L019000100PCERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE       Cerv collar supp adj cerv ba38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L019000200QCERVICAL BARS (SOMI, GUILFORD, TAYLOR TYPES)                                                                                                                                                                                                                                                                         
L020000100PCERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE       Cerv col supp adj bar & thor38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L020000200QCERVICAL BARS, AND THORACIC EXTENSION                                                                                                                                                                                                                                                                                
L021000100PTHORACIC, RIB BELT                                                              Thoracic rib belt           38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L022000100PTHORACIC, RIB BELT, CUSTOM FABRICATED                                           Thor rib belt custom fabrica38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L030000100PTHORACIC-LUMBAR-SACRAL-ORTHOSIS (TLSO), FLEXIBLE (DORSO-LUMBAR SURGICAL SUPPORT)TLSO flex surgical support  38      A                                                                                                     C                          D1F P       198601012003010120021231N                           
L031000100PTLSO, FLEXIBLE, (DORSO-LUMBAR SURGICAL SUPPORT), CUSTOM FABRICATED              Tlso flexible custom fabrica38      A                                                                                                     C                          D1F P       198201012003010120021231N                           
L031500100PTLSO, FLEXIBLE DORSO-LUMBAR SURGICAL SUPPORT, ELASTIC TYPE, WITH RIGID          Tlso flex elas rigid post pa38      A                                                                                                     C                          D1F P       198901012003010120021231N                           
L031500200QPOSTERIOR PANEL                                                                                                                                                                                                                                                                                                      
L031700100PTLSO, FLEXIBLE DORSO-LUMBAR SURGICAL SUPPORT, HYPEREXTENSION, ELASTIC TYPE,     Tlso flex hypext elas post p38      A                                                                                                     C                          D1F P       198901012003010120021231N                           
L031700200QWITH RIGID POSTERIOR PANEL                                                                                                                                                                                                                                                                                           
L032000100PTLSO, ANTERIOR-POSTERIOR CONTROL (TAYLOR TYPE), WITH APRON FRONT                Tlso a-p contrl w apron frnt38      A                                                                                                     C                          D1F P       198601012003010120021231N                           
L032100100PTLSO, ANTERIOR-POSTERIOR CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL,     Tlso anti-post-cntrl prefab 38      A                                                                                                     C                          D1F P       200201012003010120021231N                           
L032100200QPREFABRICATED (INCLUDES FITTING AND ADJUSTMENT)                                                                                                                                                                                                                                                                      
L033000100PTLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL (KNIGHT-TAYLOR TYPE), WITH APRON FRONT Tlso ant-pos-lateral control38      A                                                                                                     C                          D1F P       198201012003010120021231N                           
L033100100PTLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR    Tlso ant-post-lat cntrl prfb38      A                                                                                                     C                          D1F P       200201012003010120021231N                           
L033100200QPANEL, PREFABRICATED (INCLUDES FITTING AND ADJUSTMENT)                                                                                                                                                                                                                                                               
L034000100PTLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL (ARNOLD, MAGNUSON, STEINDLER    Tlso a-p-l-rotary with apron38      A                                                                                                     C                          D1F P       198401012003010120021231N                           
L034000200QTYPES), WITH APRON FRONT                                                                                                                                                                                                                                                                                             
L035000100PTLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, FLEXION COMPRESSION JACKET,    Tlso flex compress jacket cu38      A                                                                                                     C                          D1F P       198501012003010120021231N                           
L035000200QCUSTOM FITTED                                                                                                                                                                                                                                                                                                        
L036000100PTLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, FLEXION COMPRESSION JACKET     Tlso flex compress jacket mo38      A                                                                                                     C                          D1F P       198501012003010120021231N                           
L036000200QMOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                              
L037000100PTLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, HYPEREXTENSION (JEWETT,        Tlso a-p-l-rotary hyperexten38      A                                                                                                     C                          D1F P       198501012003010120021231N                           
L037000200QLENNOX, BAKER, CASH TYPES)                                                                                                                                                                                                                                                                                           
L038000100PTLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, WITH EXTENSIONS                Tlso a-p-l-rot w/ pos extens38      A                                                                                                     C                          D1F P       198601012003010120021231N                           
L039000100PTLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL MOLDED TO PATIENT MODEL                Tlso a-p-l control molded   38      A                                                                                                     C                          D1F P       198401012003010120021231N                           
L039100100PTLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, WITH RIGID OR SEMI-RIGID       Tlso ant-post-lat-rot cntrl 38      A                                                                                                     C                          D1F P       200201012003010120021231N                           
L039100200QPOSTERIOR PANEL, PREFABRICATED (INCLUDES FITTING AND ADJUSTMENT)                                                                                                                                                                                                                                                     
L040000100PTLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL MOLDED TO PATIENT MODEL, WITH          Tlso a-p-l w interface mater38      A                                                                                                     C                          D1F P       198601012003010120021231N                           
L040000200QINTERFACE MATERIAL                                                                                                                                                                                                                                                                                                   
L041000100PTLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, TWO-PIECE CONSTRUCTION              , Tlso a-p-l two piece constr 38      A                                                                                                     C                          D1F P       198801012003010120021231N                           
L041000200QMOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                              
L042000100PTLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, TWO PIECE CONSTRUCTION              , Tlso a-p-l 2 piece w interfa38      A                                                                                                     C                          D1F P       198801012003010120021231N                           
L042000200QMOLDED TO PATIENT MODEL, WITH INTERFACE MATERIAL                                                                                                                                                                                                                                                                     
L043000100PSPINAL ORTHOSIS, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH INTERFACE MATERIAL,   Dewall posture protector    38      A                                                                                                     C                          D1F P       1988010120050101        N                           
L043000200QCUSTOM FITTED (DEWALL POSTURE PROTECTOR ONLY)                                                                                                                                                                                                                                                                        
L044000100PTLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH OVERLAPPING FRONT SECTION,       Tlso a-p-l overlap frnt cust38      A                                                                                                     C                          D1F P       198801012003010120021231N                           
L044000200QSPRING STEEL FRONT, CUSTOM FITTED                                                                                                                                                                                                                                                                                    
L045000100PTLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, UPPER THORACIC REGION, PRODUCES         TLSO flex prefab thoracic   38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L045000200QINTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTEVERTEBRAL DISKS WITH RIGID                                                                                                                                                                                                                                          
L045000300QSTAYS OR PANEL(S), INCLUDES SHOULDER STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                             
L045000400QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L045200100PTLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, UPPER THORACIC REGION, PRODUCES         tlso flex custom fab thoraci38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L045200200QINTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS WITH RIGID                                                                                                                                                                                                                                         
L045200300QSTAYS OR PANEL(S), INCLUDES SHOULDER STRAPS AND CLOSURES, CUSTOM FABRICATED                                                                                                                                                                                                                                          
L045400100PTLSO FLEXIBLE, PROVIDES TRUNK SUPPORT, EXTENDS FROM SACROCOCCYGEAL JUNCTION TO  TLSO flex prefab sacrococ-T938      A                                                                                                     C                          D1F P       2003010120030101        N                           
L045400200QABOVE T-9 VERTEBRA, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL PLANE,                                                                                                                                                                                                                                              
L045400300QPRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS WITH                                                                                                                                                                                                                                      
L045400400QRIGID STAYS OR PANEL(S), INCLUDES SHOULDER STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L045400500QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L045600100PTLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, THORACIC REGION, RIGID POSTERIOR PANEL  TLSO flex prefab            38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L045600200QAND SOFT ANTERIOR APRON, EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                                
L045600300QTERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, RESTRICTS GROSS TRUNK MOTION IN                                                                                                                                                                                                                                      
L045600400QTHE SAGITTAL PLANE, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE                                                                                                                                                                                                                                            
L045600500QINTERVERTEBRAL DISKS, INCLUDES STRAPS AND CLOSURES, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                          
L045600600QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L045800100PTLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC     TLSO 2Mod symphis-xipho pre 38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L045800200QSHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST                                                                                                                                                                                                                                       
L045800300QINFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO                                                                                                                                                                                                                                         
L045800400QTHE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL,                                                                                                                                                                                                                                      
L045800500QAND TRANVERSE PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING PLASTIC AND                                                                                                                                                                                                                                        
L045800600QSTABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                          
L045800700QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L046000100PTLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC     TLSO2Mod symphysis-stern pre38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L046000200QSHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST                                                                                                                                                                                                                                       
L046000300QINFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO                                                                                                                                                                                                                                         
L046000400QTHE STERNAL NOTCH, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL,                                                                                                                                                                                                                                         
L046000500QCORONAL, AND TRANVERSE PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                           
L046000600QPLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L046000700QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L046200100PTLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID PLASTIC   TLSO 3Mod sacro-scap pre    38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L046200200QSHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST                                                                                                                                                                                                                                       
L046200300QINFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO                                                                                                                                                                                                                                         
L046200400QTHE STERNAL NOTCH, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL,                                                                                                                                                                                                                                         
L046200500QCORONAL, AND TRANSVERSE PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                          
L046200600QPLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L046200700QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L046400100PTLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, FOUR RIGID PLASTIC    TLSO 4Mod sacro-scap pre    38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L046400200QSHELLS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES JUST                                                                                                                                                                                                                                           
L046400300QINFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO THE                                                                                                                                                                                                                                             
L046400400QSTERNAL NOTCH, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, CORONAL,                                                                                                                                                                                                                                        
L046400500QAND TRANVERSE PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING PLASTIC AND                                                                                                                                                                                                                                        
L046400600QSTABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                          
L046400700QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L046600100PTLSO, SAGITTAL CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT ANTERIOR APRON  TLSO rigid frame pre soft ap38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L046600200QWITH STRAPS, CLOSURES AND PADDING, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL                                                                                                                                                                                                                                          
L046600300QPLANE, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISKS,                                                                                                                                                                                                                                       
L046600400QINCLUDES FITTING AND SHAPING THE FRAME, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                          
L046600500QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L046800100PTLSO, SAGITTAL-CORONAL CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT         TLSO rigid frame prefab pelv38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L046800200QANTERIOR APRON WITH STRAPS, CLOSURES AND PADDING, EXTENDS FROM SACROCOCCYGEAL                                                                                                                                                                                                                                        
L046800300QJUNCTION OVER SCAPULAE, LATERAL STRENGTH PROVIDED BY PELVIC, THORACIC, AND                                                                                                                                                                                                                                           
L046800400QLATERAL FRAME PIECES, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, AND CORONAL                                                                                                                                                                                                                                          
L046800500QPLANES, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISKS,                                                                                                                                                                                                                                      
L046800600QINCLUDES FITTING AND SHAPING THE FRAME, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                          
L046800700QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L047000100PTLSO, TRIPLANAR CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT ANTERIOR APRON TLSO rigid frame pre subclav38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L047000200QWITH STRAPS, CLOSURES AND PADDING, EXTENDS FROM SACROCOCCYGEAL JUNCTION TO                                                                                                                                                                                                                                           
L047000300QSCAPULA, LATERAL STRENGTH PROVIDED BY PELVIC, THORACIC, AND LATERAL FRAME                                                                                                                                                                                                                                            
L047000400QPIECES, ROTATIONAL STRENGTH PROVIDED BY SUBCLAVICULAR EXTENSIONS, RESTRICTS                                                                                                                                                                                                                                          
L047000500QGROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND TRANVERSE PLANES, PRODUCES                                                                                                                                                                                                                                              
L047000600QINTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS, INCLUDES                                                                                                                                                                                                                                          
L047000700QFITTING AND SHAPING THE FRAME, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                        
L047200100PTLSO, TRIPLANAR CONTROL, HYPEREXTENSION, RIGID ANTERIOR AND LATERAL FRAME       TLSO rigid frame hyperex pre38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L047200200QEXTENDS FROM SYMPHYSIS PUBIS TO STERNAL NOTCH WITH TWO ANTERIOR COMPONENTS (ONE                                                                                                                                                                                                                                      
L047200300QPUBIC AND ONE STERNAL), POSTERIOR AND LATERAL PADS WITH STRAPS AND CLOSURES,                                                                                                                                                                                                                                         
L047200400QLIMITS SPINAL FLEXION, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND                                                                                                                                                                                                                                        
L047200500QTRANSVERSE PLANES, INCLUDES FITTING AND SHAPING THE FRAME, PREFABRICATED,                                                                                                                                                                                                                                            
L047200600QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L047600100PTLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC   TLSO flexion compres jac pre38      A                                                                                                     C                          D1F P       200301012005010120041231N                           
L047600200QSHELLS WITH SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                           
L047600300QTERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS                                                                                                                                                                                                                                      
L047600400QTO XIPHOID, USUALLY LACED TOGETHER ON ONE SIDE, RESTRICTS GROSS TRUNK MOTION IN                                                                                                                                                                                                                                      
L047600500QSAGITTAL AND CORONAL PLANES, ALLOWS FREE FLEXION AND COMPRESSION OF THE LS                                                                                                                                                                                                                                           
L047600600QREGION, INCLUDES STRAPS AND CLOSURES, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                            
L047600700QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L047800100PTLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC   TLSO flexion compres jac cus38      A                                                                                                     C                          D1F P       200301012005010120041231N                           
L047800200QSHELLS WITH SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                           
L047800300QTERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS                                                                                                                                                                                                                                      
L047800400QTO XIPHOID, USUALLY LACED TOGETHER ON ONE SIDE, RESTRICTS GROSS TRUNK MOTION IN                                                                                                                                                                                                                                      
L047800500QSAGITTAL AND CORONAL PLANES, ALLOWS FREE FLEXION AND COMPRESSION OF LS REGION,                                                                                                                                                                                                                                       
L047800600QINCLUDES STRAPS AND CLOSURES, CUSTOM FABRICATED                                                                                                                                                                                                                                                                      
L048000100PTLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITHOUT INTERFACE LINER, TLSO rigid plastic custom fa38      A                                                                                                     C                          D1F P       2003010120040101        N                           
L048000200QWITH MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL                                                                                                                                                                                                                                             
L048000300QJUNCTION AND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM                                                                                                                                                                                                                                       
L048000400QSYMPHYSIS PUBIS TO STERNAL NOTCH, ANTERIOR OR POSTERIOR OPENING, RESTRICTS                                                                                                                                                                                                                                           
L048000500QGROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND TRANSVERSE PLANES, INCLUDES A                                                                                                                                                                                                                                           
L048000600QCARVED PLASTER OR CAD-CAM MODEL, CUSTOM FABRICATED                                                                                                                                                                                                                                                                   
L048200100PTLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER,    TLSO rigid lined custom fab 38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L048200200QMULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION                                                                                                                                                                                                                                         
L048200300QAND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS                                                                                                                                                                                                                                      
L048200400QPUBIS TO STERNAL NOTCH, ANTERIOR OR POSTERIOR OPENING, RESTRICTS GROSS TRUNK                                                                                                                                                                                                                                         
L048200500QMOTION IN SAGITTAL, CORONAL, AND TRANSVERSE PLANES, INCLUDES A CARVED PLASTER                                                                                                                                                                                                                                        
L048200600QOR CAD-CAM MODEL, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                  
L048400100PTLSO, TRIPLANAR CONTROL, TWO PIECE RIGID PLASTIC SHELL WITHOUT INTERFACE LINER, TLSO rigid plastic cust fab 38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L048400200QWITH MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL                                                                                                                                                                                                                                             
L048400300QJUNCTION AND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM                                                                                                                                                                                                                                       
L048400400QSYMPHYSIS PUBIS TO STERNAL NOTCH, LATERAL STRENGTH IS ENHANCED BY OVERLAPPING                                                                                                                                                                                                                                        
L048400500QPLASTIC, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL, AND TRANSVERSE                                                                                                                                                                                                                                       
L048400600QPLANES, INCLUDES A CARVED PLASTER OR CAD-CAM MODEL, CUSTOM FABRICATED                                                                                                                                                                                                                                                
L048600100PTLSO, TRIPLANAR CONTROL, TWO PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER,    TLSO rigidlined cust fab two38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L048600200QMULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION                                                                                                                                                                                                                                         
L048600300QAND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS                                                                                                                                                                                                                                      
L048600400QPUBIS TO STERNAL NOTCH, LATERAL STRENGTH IS ENHANCED BY OVERLAPPING PLASTIC,                                                                                                                                                                                                                                         
L048600500QRESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL, AND TRANSVERSE PLANES,                                                                                                                                                                                                                                        
L048600600QINCLUDES A CARVED PLASTER OR CAD-CAM MODEL, CUSTOM FABRICATED                                                                                                                                                                                                                                                        
L048800100PTLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER,    TLSO rigid lined pre one pie38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L048800200QMULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION                                                                                                                                                                                                                                         
L048800300QAND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS                                                                                                                                                                                                                                      
L048800400QPUBIS TO STERNAL NOTCH, ANTERIOR OR POSTERIOR OPENING, RESTRICTS GROSS TRUNK                                                                                                                                                                                                                                         
L048800500QMOTION IN SAGITTAL, CORONAL, AND TRANSVERSE PLANES, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                          
L048800600QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L049000100PTLSO, SAGITTAL-CORONAL CONTROL, ONE PIECE RIGID PLASTIC SHELL, WITH OVERLAPPING TLSO rigid plastic pre one  38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L049000200QREINFORCED ANTERIOR, WITH MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM                                                                                                                                                                                                                                       
L049000300QSACROCOCCYGEAL JUNCTION AND TERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                       
L049000400QEXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, ANTERIOR OPENING, RESTRICTS GROSS                                                                                                                                                                                                                                           
L049000500QTRUNK MOTION IN SAGITTAL AND CORONAL PLANES, PREFABRICATED, INCLUDES FITTING                                                                                                                                                                                                                                         
L049000600QAND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L049100100PTLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID      TLSO 2 piece rigid shell    38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L049100200QPLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                               
L049100300QTERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE                                                                                                                                                                                                                                            
L049100400QSYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE                                                                                                                                                                                                                                      
L049100500QSAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                             
L049100600QPLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L049100700QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L049200100PTLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID    TLSO 3 piece rigid shell    38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L049200200QPLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                               
L049200300QTERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE                                                                                                                                                                                                                                            
L049200400QSYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE                                                                                                                                                                                                                                      
L049200500QSAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                             
L049200600QPLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L049200700QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L050000100PLUMBAR-SACRAL-ORTHOSIS (LSO), FLEXIBLE, (LUMBO-SACRAL SUPPORT)                  Lso flex surgical support   38      A                                                                                                     C                          D1F P       198601012005010120041231N                           
L051000100PLSO, FLEXIBLE (LUMBO-SACRAL SUPPORT), CUSTOM FABRICATED                         Lso flexible custom fabricat38      A                                                                                                     C                          D1F P       198201012005010120041231N                           
L051500100PLSO, ANTERIOR-POSTERIOR CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL,      Lso flex elas w/ rig post pa38      A                                                                                                     C                          D1F P       198801012005010120041231N                           
L051500200QPREFABRICATED                                                                                                                                                                                                                                                                                                        
L052000100PLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL (KNIGHT, WILCOX TYPES), WITH APRON FRONTLso a-p-l control with apron38      A                                                                                                     C                          D1F P       198501012005010120041231N                           
L053000100PLSO, ANTERIOR-POSTERIOR CONTROL (MACAUSLAND TYPE), WITH APRON FRONT             Lso ant-pos control w apron 38      A                                                                                                     C                          D1F P       198401012005010120041231N                           
L054000100PLSO, LUMBAR FLEXION (WILLIAMS FLEXION TYPE)                                     Lso lumbar flexion a-p-l    38      A                                                                                                     C                          D1F P       198501012005010120041231N                           
L055000100PLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL                Lso a-p-l control molded    38      A                                                                                                     C                          D1F P       198401012005010120041231N                           
L056000100PLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL, WITH          Lso a-p-l w interface       38      A                                                                                                     C                          D1F P       198601012005010120041231N                           
L056000200QINTERFACE MATERIAL                                                                                                                                                                                                                                                                                                   
L056100100PLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR     Prefab lso                  38      A                                                                                                     C                          D1F P       200201012005010120041231N                           
L056100200QPANEL, PREFABRICATED                                                                                                                                                                                                                                                                                                 
L056500100PLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, CUSTOM FITTED                          Lso a-p-l control custom    38      A                                                                                                     C                          D1F P       198801012005010120041231N                           
L060000100PSACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT),                             Sacroiliac flex surg support38      A                                                                                                     C                          D1F P       198201012005010120041231N                           
L061000100PSACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT), CUSTOM FABRICATED           Sacroiliac flexible custm fa38      A                                                                                                     C                          D1F P       198201012005010120041231N                           
L062000100PSACROILIAC, SEMI-RIGID (GOLDTHWAITE, OSGOOD TYPES), WITH APRON FRONT            Sacroiliac semi-rig w apron 38      A                                                                                                     C                          D1F P       198201012005010120041231N                           
L062100100PSACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION   SIO flex pelvisacral prefab 38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L062100200QABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS                                                                                                                                                                                                                                         
L062100300QABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
L062200100PSACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION   SIO flex pelvisacral custom 38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L062200200QABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS                                                                                                                                                                                                                                         
L062200300QABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                    
L062300100PSACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID   SIO panel prefab            38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L062300200QPANELS OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT,                                                                                                                                                                                                                                       
L062300300QINCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                      
L062300400QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L062400100PSACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID   SIO panel custom            38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L062400200QPANELS PLACED OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC                                                                                                                                                                                                                                       
L062400300QJOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM                                                                                                                                                                                                                                       
L062400400QFABRICATED                                                                                                                                                                                                                                                                                                           
L062500100PLUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT, POSTERIOR EXTENDS FROM L-1  LO flexibl L1-below L5 pre  38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L062500200QTO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE                                                                                                                                                                                                                                         
L062500300QINTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN                                                                                                                                                                                                                                       
L062500400QDESIGN, SHOULDER STRAPS, STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                       
L062600100PLUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR     LO sag stays/panels pre-fab 38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L062600200QEXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                           
L062600300QREDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE                                                                                                                                                                                                                                      
L062600400QPADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                            
L062600500QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L062700100PLUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS,    LO sagitt rigid panel prefab38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L062700200QPOSTERIOR EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                             
L062700300QPRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L062700400QMAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                       
L062700500QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L062800100PLUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR      LO flex w/o rigid stays pre 38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L062800200QEXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                         
L062800300QPRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L062800400QMAY INCLUDE STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                         
L062800500QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L062900100PLUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR      LSO flex w/rigid stays cust 38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L062900200QEXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                         
L062900300QPRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L062900400QMAY INCLUDE STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                      
L063000100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S),        LSO post rigid panel pre    38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063000200QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES                                                                                                                                                                                                                                             
L063000300QINTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES                                                                                                                                                                                                                                          
L063000400QSTRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS                                                                                                                                                                                                                                             
L063000500QABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
L063100100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR     LSO sag-coro rigid frame pre38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063100200QPANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                              
L063100300QPRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,                                                                                                                                                                                                                                          
L063100400QINCLUDES STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                       
L063100500QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L063200100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR     LSO sag rigid frame cust    38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063200200QPANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                              
L063200300QPRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,                                                                                                                                                                                                                                          
L063200400QINCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS                                                                                                                                                                                                                                           
L063200500QABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                    
L063300100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR          LSO flexion control prefab  38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063300200QFRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                      
L063300300QLATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                      
L063300400QPRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
L063300500QINCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                                   
L063300600QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L063400100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR          LSO flexion control custom  38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063400200QFRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                      
L063400300QLATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANEL(S), PRODUCES                                                                                                                                                                                                                                                  
L063400400QINTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
L063400500QCLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN                                                                                                                                                                                                                                             
L063400600QDESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                            
L063500100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID         LSO sagit rigid panel prefab38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063500200QPOSTERIOR FRAME/PANEL(S), LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE,                                                                                                                                                                                                                                      
L063500300QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL                                                                                                                                                                                                                                              
L063500400QSTRENGTH PROVIDED BY RIGID LATERAL FRAME/PANEL(S), PRODUCES INTRACAVITARY                                                                                                                                                                                                                                            
L063500500QPRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
L063500600QINCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                            
L063500700QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L063600100PLUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID         LSO sagittal rigid panel cus38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063600200QPOSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE,                                                                                                                                                                                                                                        
L063600300QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL                                                                                                                                                                                                                                              
L063600400QSTRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                              
L063600500QPRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
L063600600QINCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                         
L063700100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND       LSO sag-coronal panel prefab38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063700200QPOSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9                                                                                                                                                                                                                                        
L063700300QVERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES                                                                                                                                                                                                                                          
L063700400QINTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
L063700500QCLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                            
L063700600QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L063800100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND       LSO sag-coronal panel custom38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063800200QPOSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9                                                                                                                                                                                                                                        
L063800300QVERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES                                                                                                                                                                                                                                          
L063800400QINTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
L063800500QCLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                            
L063800600QCUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
L063900100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S),      LSO s/c shell/panel prefab  38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L063900200QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                             
L063900300QEXTENDS FROM SYMPHYSIS PUBIS TO XYPHOID, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                          
L063900400QREDUCE LOAD ON THE INTERVERTEBRAL DISCS, OVERALL STRENGTH IS PROVIDED BY                                                                                                                                                                                                                                             
L063900500QOVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L063900600QMAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                        
L063900700QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L064000100PLUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S),      LSO s/c shell/panel custom  38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L064000200QPOSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                             
L064000300QEXTENDS FROM SYMPHYSIS PUBIS TO XYPHOID, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                          
L064000400QREDUCE LOAD ON THE INTERVERTEBRAL DISCS, OVERALL STRENGTH IS PROVIDED BY                                                                                                                                                                                                                                             
L064000500QOVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L064000600QMAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                              
L070000100PCERVICAL-THORACIC-LUMBAR-SACRAL-ORTHOSES (CTLSO), ANTERIOR-POSTERIOR-LATERAL    Ctlso a-p-l control molded  38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L070000200QCONTROL, MOLDED TO PATIENT MODEL, (MINERVA TYPE)                                                                                                                                                                                                                                                                     
L071000100PCTLSO, ANTERIOR-POSTERIOR-LATERAL-CONTROL, MOLDED TO PATIENT MODEL, WITH        Ctlso a-p-l control w/ inter38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L071000200QINTERFACE MATERIAL, (MINERVA TYPE)                                                                                                                                                                                                                                                                                   
L081000100PHALO PROCEDURE,  CERVICAL HALO INCORPORATED INTO JACKET VEST                    Halo cervical into jckt vest38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L082000100PHALO PROCEDURE,  CERVICAL HALO INCORPORATED INTO PLASTER BODY JACKET            Halo cervical into body jack38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L083000100PHALO PROCEDURE,  CERVICAL HALO INCORPORATED INTO MILWAUKEE TYPE ORTHOSIS        Halo cerv into milwaukee typ38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L085900100PADDITION TO HALO PROCEDURE, MAGNETIC RESONANCE IMAGE COMPATIBLE SYSTEMS, RINGS  MRI compatible system       38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L085900200QAND PINS, ANY MATERIAL                                                                                                                                                                                                                                                                                               
L086000100PADDITION TO HALO PROCEDURES, MAGNETIC REASONANCE IMAGE COMPATIBLE SYSTEM        Magnetic resonanc image comp38      A                                                                            L0859                    C                          D1F P       198901012006010120051231D                           
L086100100PADDITION TO HALO PROCEDURE, REPLACEMENT LINER/INTERFACE MATERIAL                Halo repl liner/interface   38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L090000100PTORSO SUPPORT,  PTOSIS SUPPORT                                                  Torso/ptosis support        38      A                                                                            L0500                    C                          D1F P       198601012003010120021231N                           
L091000100PTORSO SUPPORT,  PTOSIS SUPPORT, CUSTOM FABRICATED                               Torso & ptosis supp custm fa38      A                                                                            L0510                    C                          D1F P       198601012003010120021231N                           
L092000100PTORSO SUPPORT,  PENDULOUS ABDOMEN SUPPORT                                       Torso/pendulous abd support 38      A                                                                            L0500                    C                          D1F P       198601012003010120021231N                           
L093000100PTORSO SUPPORT,  PENDULOUS ABDOMEN SUPPORT, CUSTOM FABRICATED                    Pendulous abdomen supp custm38      A                                                                            L0510                    C                          D1F P       198601012003010120021231N                           
L094000100PTORSO SUPPORT,  POSTSURGICAL SUPPORT                                            Torso/postsurgical support  38      A                                                                            L0500                    C                          D1F P       198601012003010120021231N                           
L095000100PTORSO SUPPORT,  POST SURGICAL SUPPORT, CUSTOM FABRICATED                        Post surg support custom fab38      A                                                                            L0510                    C                          D1F P       198601012003010120021231N                           
L096000100PTORSO SUPPORT,  POST SURGICAL SUPPORT, PADS FOR POST SURGICAL SUPPORT           Post surgical support pads  38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L097000100PTLSO, CORSET FRONT                                                              Tlso corset front           38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L097200100PLSO, CORSET FRONT                                                               Lso corset front            38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L097400100PTLSO, FULL CORSET                                                               Tlso full corset            38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L097600100PLSO, FULL CORSET                                                                Lso full corset             38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L097800100PAXILLARY CRUTCH EXTENSION                                                       Axillary crutch extension   38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L098000100PPERONEAL STRAPS, PAIR                                                           Peroneal straps pair        38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L098200100PSTOCKING SUPPORTER GRIPS, SET OF FOUR (4)                                       Stocking supp grips set of f38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L098400100PPROTECTIVE BODY SOCK, EACH                                                      Protective body sock each   38      A                                                                                                     C                          D1F P       1994010119960101        N                           
L098600100PADDITION TO SPINAL ORTHOSIS, RIGID OR SEMI-RIGID ABDOMINAL PANEL, PREFABRICATED Spinal orth abdm pnl prefab 38      A                                                                                                     C                          D1F P       200201012003010120021231N                           
L099900100PADDITION TO SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED                            Add to spinal orthosis NOS  46      A                                                                                                     C                          D1F P       1998010119980101        N                           
L100000100PCERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) (MILWAUKEE), INCLUSIVE OF      Ctlso milwauke initial model38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L100000200QFURNISHING INITIAL ORTHOSIS, INCLUDING MODEL                                                                                                                                                                                                                                                                         
L100500100PTENSION BASED SCOLIOSIS ORTHOSIS AND ACCESSORY PADS, INCLUDES FITTING AND       Tension based scoliosis orth38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L100500200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L101000100PADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS       Ctlso axilla sling          38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L101000200QORTHOSIS, AXILLA SLING                                                                                                                                                                                                                                                                                               
L102000100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD                           Kyphosis pad                38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L102500100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD, FLOATING                 Kyphosis pad floating       38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L103000100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR BOLSTER PAD                     Lumbar bolster pad          38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L104000100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR OR LUMBAR RIB PAD               Lumbar or lumbar rib pad    38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L105000100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, STERNAL PAD                            Sternal pad                 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L106000100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, THORACIC PAD                           Thoracic pad                38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L107000100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, TRAPEZIUS SLING                        Trapezius sling             38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L108000100PADDITION  TO CTLSO OR SCOLIOSIS ORTHOSIS, OUTRIGGER                             Outrigger                   38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L108500100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, OUTRIGGER, BILATERAL WITH VERTICAL     Outrigger bil w/ vert extens38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L108500200QEXTENSIONS                                                                                                                                                                                                                                                                                                           
L109000100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR SLING                           Lumbar sling                38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L110000100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, RING FLANGE, PLASTIC OR LEATHER        Ring flange plastic/leather 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L111000100PADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, RING FLANGE, PLASTIC OR LEATHER,       Ring flange plas/leather mol38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L111000200QMOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                              
L112000100PADDITION TO CTLSO, SCOLIOSIS ORTHOSIS, COVER FOR UPRIGHT, EACH                  Covers for upright each     38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L120000100PTHORACIC-LUMBAR-SACRAL-ORTHOSIS (TLSO), INCLUSIVE OF FURNISHING INITIAL         Furnsh initial orthosis only38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L120000200QORTHOSIS ONLY                                                                                                                                                                                                                                                                                                        
L121000100PADDITION TO TLSO, (LOW PROFILE), LATERAL THORACIC EXTENSION                     Lateral thoracic extension  38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L122000100PADDITION TO TLSO, (LOW PROFILE), ANTERIOR THORACIC EXTENSION                    Anterior thoracic extension 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L123000100PADDITION TO TLSO, (LOW PROFILE), MILWAUKEE TYPE SUPERSTRUCTURE                  Milwaukee type superstructur38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L124000100PADDITION TO TLSO, (LOW PROFILE), LUMBAR DEROTATION PAD                          Lumbar derotation pad       38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L125000100PADDITION TO TLSO, (LOW PROFILE), ANTERIOR ASIS PAD                              Anterior asis pad           38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L126000100PADDITION TO TLSO, (LOW PROFILE), ANTERIOR THORACIC DEROTATION PAD               Anterior thoracic derotation38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L127000100PADDITION TO TLSO, (LOW PROFILE), ABDOMINAL PAD                                  Abdominal pad               38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L128000100PADDITION TO TLSO, (LOW PROFILE), RIB GUSSET (ELASTIC), EACH                     Rib gusset (elastic) each   38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L129000100PADDITION TO TLSO, (LOW PROFILE), LATERAL TROCHANTERIC PAD                       Lateral trochanteric pad    38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L130000100POTHER SCOLIOSIS PROCEDURE, BODY JACKET MOLDED TO PATIENT MODEL                  Body jacket mold to patient 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L131000100POTHER SCOLIOSIS PROCEDURE,  POST-OPERATIVE BODY JACKET                          Post-operative body jacket  38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L149900100PSPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED                                        Spinal orthosis NOS         46      A                                                                                                     C                          D1F P       1982010119980101        N                           
L150000100PTHORACIC-HIP-KNEE-ANKLE ORTHOSIS (THKAO), MOBILITY FRAME (NEWINGTON, PARAPODIUM Thkao mobility frame        38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L150000200QTYPES)                                                                                                                                                                                                                                                                                                               
L151000100PTHKAO, STANDING FRAME, WITH OR WITHOUT TRAY AND ACCESSORIES                     Thkao standing frame        38      A                                                                                                     C                          D1F P       1982010120020101        N                           
L152000100PTHKAO, SWIVEL WALKER                                                            Thkao swivel walker         38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L160000100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, FREJKA TYPE WITH       Abduct hip flex frejka w cvr38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L160000200QCOVER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                
L161000100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (FREJKA COVER ONLY),   Abduct hip flex frejka covr 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L161000200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L162000100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (PAVLIK HARNESS),      Abduct hip flex pavlik harne38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L162000200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L163000100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, SEMI-FLEXIBLE (VON ROSEN TYPE),  Abduct control hip semi-flex38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L163000200QCUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L164000100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, PELVIC BAND OR SPREADER  Pelv band/spread bar thigh c38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L164000200QBAR, THIGH CUFFS, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                  
L165000100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, ADJUSTABLE, (ILFLED      HO abduction hip adjustable 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L165000200QTYPE), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                
L165200100PHIP ORTHOSIS, BILATERAL THIGH CUFFS WITH ADJUSTABLE ABDUCTOR SPREADER BAR,      HO bi thighcuffs w sprdr bar38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L165200200QADULT SIZE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ANY TYPE                                                                                                                                                                                                                                                 
L166000100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, PLASTIC, PREFABRICATED,  HO abduction static plastic 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L166000200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L168000100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, DYNAMIC, PELVIC CONTROL,         Pelvic & hip control thigh c38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L168000200QADJUSTABLE HIP MOTION CONTROL, THIGH CUFFS (RANCHO HIP ACTION TYPE), CUSTOM                                                                                                                                                                                                                                          
L168000300QFABRICATED                                                                                                                                                                                                                                                                                                           
L168500100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE, Post-op hip abduct custom fa38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L168500200QCUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
L168600100PHIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE, HO post-op hip abduction    38      A                                                                                                     C                          D1F P       1989010120010101        N                           
L168600200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L169000100PCOMBINATION, BILATERAL, LUMBO-SACRAL, HIP, FEMUR ORTHOSIS PROVIDING ADDUCTION   Combination bilateral HO    38      A                                                                                                     C                          D1F P       1999010120010101        N                           
L169000200QAND INTERNAL ROTATION CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                        
L170000100PLEGG PERTHES ORTHOSIS, (TORONTO TYPE), CUSTOM-FABRICATED                        Leg perthes orth toronto typ38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L171000100PLEGG PERTHES ORTHOSIS, (NEWINGTON TYPE), CUSTOM FABRICATED                      Legg perthes orth newington 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L172000100PLEGG PERTHES ORTHOSIS, TRILATERAL, (TACHDIJAN TYPE), CUSTOM-FABRICATED          Legg perthes orthosis trilat38      A                                                                                                     C                          D1F P       1985010120010101        N                           
L173000100PLEGG PERTHES ORTHOSIS, (SCOTTISH RITE TYPE), CUSTOM-FABRICATED                  Legg perthes orth scottish r38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L175000100PLEGG PERTHES ORTHOSIS, LEGG PERTHES SLING (SAM BROWN TYPE), PREFABRICATED,      Legg perthes sling          38      A                                                                            A4565                    C                          D1F P       198201012006010120051231D                           
L175000200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L175500100PLEGG PERTHES ORTHOSIS, (PATTEN BOTTOM TYPE), CUSTOM-FABRICATED                  Legg perthes patten bottom t38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L180000100PKNEE ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND          Knee orthoses elas w stays  38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L180000200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L181000100PKNEE ORTHOSIS, ELASTIC WITH JOINTS, PREFABRICATED, INCLUDES FITTING AND         Ko elastic with joints      38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L181000200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L181500100PKNEE ORTHOSIS, ELASTIC OR OTHER ELASTIC TYPE MATERIAL WITH CONDYLAR PAD(S),     Elastic with condylar pads  38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L181500200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L182000100PKNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR  Ko elas w/ condyle pads & jo38      A                                                                                                     C                          D1F P       1986010120050101        N                           
L182000200QCONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                              
L182500100PKNEE ORTHOSIS, ELASTIC KNEE CAP, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT Ko elastic knee cap         38      A                                                                                                     C                          D1F P       1985010120010101        N                           
L183000100PKNEE ORTHOSIS, IMMOBILIZER, CANVAS LONGITUDINAL, PREFABRICATED, INCLUDES        Ko immobilizer canvas longit38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L183000200QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L183100100PKNEE ORTHOSIS, LOCKING KNEE JOINT(S), POSITIONAL ORTHOSIS, PREFABRICATED,       Knee orth pos locking joint 38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L183100200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L183200100PKNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL   KO adj jnt pos rigid support38      A                                                                                                     C                          D1F P       1989010120060101        C                           
L183200200QORTHOSIS, RIGID SUPPORT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                              
L183400100PKNEE ORTHOSIS, WITHOUT KNEE JOINT, RIGID, CUSTOM-FABRICATED                     Ko w/0 joint rigid molded to38      A                                                                                                     C                          D1F P       1989010120010101        N                           
L183600100PKNEE ORTHOSIS, RIGID, WITHOUT JOINT(S), INCLUDES SOFT INTERFACE MATERIAL,       Rigid KO wo joints          38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L183600200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L184000100PKNEE ORTHOSIS, DEROTATION, MEDIAL-LATERAL, ANTERIOR CRUCIATE LIGAMENT, CUSTOM   Ko derot ant cruciate custom38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L184000200QFABRICATED                                                                                                                                                                                                                                                                                                           
L184300100PKNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND      KO single upright custom fit38      A                                                                                                     C                          D1F P       1998010120060101        C                           
L184300200QEXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION                                                                                                                                                                                                                                             
L184300300QCONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT,  PREFABRICATED, INCLUDES                                                                                                                                                                                                                                           
L184300400QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L184400100PKNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND      Ko w/adj jt rot cntrl molded38      A                                                                                                     C                          D1F P       1993010120060101        C                           
L184400200QEXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION                                                                                                                                                                                                                                             
L184400300QCONTROL, WITH OR WITHOUT  VARUS/VALGUS ADJUSTMENT, CUSTOM FABRICATED                                                                                                                                                                                                                                                 
L184500100PKNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND      Ko w/ adj flex/ext rotat cus38      A                                                                                                     C                          D1F P       1988010120060101        C                           
L184500200QEXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION                                                                                                                                                                                                                                             
L184500300QCONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                            
L184500400QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L184600100PKNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND      Ko w adj flex/ext rotat mold38      A                                                                                                     C                          D1F P       1988010120060101        C                           
L184600200QEXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION                                                                                                                                                                                                                                             
L184600300QCONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, CUSTOM FABRICATED                                                                                                                                                                                                                                                  
L184700100PKNEE ORTHOSIS, DOUBLE UPRIGHT WITH ADJUSTABLE JOINT, WITH INFLATABLE AIR        KO adjustable w air chambers38      A                                                                                                     C                          D1F P       1999010120010101        N                           
L184700200QSUPPORT CHAMBER(S), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                   
L185000100PKNEE ORTHOSIS, SWEDISH TYPE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT     Ko swedish type             38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L185500100PKNEE ORTHOSIS, MOLDED PLASTIC, THIGH AND CALF SECTIONS, WITH DOUBLE UPRIGHT     Ko plas doub upright jnt mol38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L185500200QKNEE JOINTS, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                       
L185800100PKNEE ORTHOSIS, MOLDED PLASTIC, POLYCENTRIC KNEE JOINTS, PNEUMATIC KNEE PADS     Ko polycentric pneumatic pad38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L185800200Q(CTI), CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                             
L186000100PKNEE ORTHOSIS, MODIFICATION OF SUPRACONDYLAR PROSTHETIC SOCKET,                 Ko supracondylar socket mold38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L186000200QCUSTOM-FABRICATED (SK)                                                                                                                                                                                                                                                                                               
L187000100PKNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF LACERS WITH KNEE JOINTS,          Ko doub upright lacers molde38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L187000200QCUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L188000100PKNEE ORTHOSIS, DOUBLE UPRIGHT, NON-MOLDED THIGH AND CALF CUFFS/LACERS WITH KNEE Ko doub upright cuffs/lacers38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L188000200QJOINTS, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                            
L188500100PKNEE ORTHOSIS, SINGLE OR DOUBLE UPRIGHT, THIGH AND CALF, WITH FUNCTIONAL ACTIVE Knee upright w/resistance   38      A                                                                            E1810                    C                          D1F P       199601012004010120031231N                           
L188500200QRESISTANCE CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                   
L190000100PANKLE FOOT ORTHOSIS, SPRING WIRE, DORSIFLEXION ASSIST CALF BAND,                Afo sprng wir drsflx calf bd38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L190000200QCUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L190100100PANKLE ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G.   Prefab ankle orthosis       38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L190100200QNEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                                     
L190200100PANKLE FOOT ORTHOSIS, ANKLE GAUNTLET, PREFABRICATED, INCLUDES FITTING AND        Afo ankle gauntlet          38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L190200200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L190400100PANKLE FOOT ORTHOSIS, MOLDED ANKLE GAUNTLET, CUSTOM-FABRICATED                   Afo molded ankle gauntlet   38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L190600100PANKLE FOOT ORTHOSIS, MULTILIGAMENTUS ANKLE SUPPORT, PREFABRICATED, INCLUDES     Afo multiligamentus ankle su38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L190600200QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L190700100PAFO, SUPRAMALLEOLAR WITH STRAPS, WITH OR WITHOUT INTERFACE/PADS, CUSTOM         AFO supramalleolar custom   38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L190700200QFABRICATED                                                                                                                                                                                                                                                                                                           
L191000100PANKLE FOOT ORTHOSIS, POSTERIOR, SINGLE BAR, CLASP ATTACHMENT TO SHOE COUNTER,   Afo sing bar clasp attach sh38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L191000200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L192000100PANKLE FOOT ORTHOSIS, SINGLE UPRIGHT WITH STATIC OR ADJUSTABLE STOP (PHELPS OR   Afo sing upright w/ adjust s38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L192000200QPERLSTEIN TYPE), CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                   
L193000100PANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING Afo plastic                 38      A                                                                                                     C                          D1F P       1982010120020101        N                           
L193000200QAND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L193200100PAFO, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL,       Afo rig ant tib prefab TCF/=38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L193200200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L194000100PANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, CUSTOM-FABRICATED               Afo molded to patient plasti38      A                                                                                                     C                          D1F P       1982010120020101        N                           
L194500100PANKLE FOOT ORTHOSIS, PLASTIC, RIGID ANTERIOR TIBIAL SECTION (FLOOR REACTION),   Afo molded plas rig ant tib 38      A                                                                                                     C                          D1F P       1989010120010101        N                           
L194500200QCUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L195000100PANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE),       Afo spiral molded to pt plas38      A                                                                                                     C                          D1F P       1982010120040101        N                           
L195000200QPLASTIC, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                           
L195100100PANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE),       AFO spiral prefabricated    38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L195100200QPLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                            
L196000100PANKLE FOOT ORTHOSIS, POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM-FABRICATED          Afo pos solid ank plastic mo38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L197000100PANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM-FABRICATED                Afo plastic molded w/ankle j38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L197100100PANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, PREFABRICATED, AFO w/ankle joint, prefab   38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L197100200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L198000100PANKLE FOOT ORTHOSIS, SINGLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP,   Afo sing solid stirrup calf 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L198000200QCALF BAND/CUFF (SINGLE BAR 'BK' ORTHOSIS), CUSTOM-FABRICATED                                                                                                                                                                                                                                                         
L199000100PANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP,   Afo doub solid stirrup calf 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L199000200QCALF BAND/CUFF (DOUBLE BAR 'BK' ORTHOSIS), CUSTOM-FABRICATED                                                                                                                                                                                                                                                         
L200000100PKNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE KNEE, FREE ANKLE, SOLID STIRRUP, Kafo sing fre stirr thi/calf38      A                                                                                                     C                          D1F P       1985010120010101        N                           
L200000200QTHIGH AND CALF BANDS/CUFFS (SINGLE BAR 'AK' ORTHOSIS), CUSTOM-FABRICATED                                                                                                                                                                                                                                             
L200500100PKNEE ANKLE FOOT ORTHOSIS, ANY MATERIAL, SINGLE OR DOUBLE UPRIGHT, STANCE        KAFO sng/dbl mechanical act 38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L200500200QCONTROL, AUTOMATIC LOCK AND SWING PHASE RELEASE, MECHANICAL ACTIVATION,                                                                                                                                                                                                                                              
L200500300QINCLUDES ANKLE JOINT, ANY TYPE, CUSTOM FABRICATED                                                                                                                                                                                                                                                                    
L201000100PKNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND  Kafo sng solid stirrup w/o j38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L201000200QCALF BANDS/CUFFS (SINGLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT,                                                                                                                                                                                                                                                     
L201000300QCUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L202000100PKNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND  Kafo dbl solid stirrup band/38      A                                                                                                     C                          D1F P       1985010120010101        N                           
L202000200QCALF BANDS/CUFFS (DOUBLE BAR 'AK' ORTHOSIS), CUSTOM-FABRICATED                                                                                                                                                                                                                                                       
L203000100PKNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND  Kafo dbl solid stirrup w/o j38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L203000200QCALF BANDS/CUFFS, (DOUBLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT, CUSTOM                                                                                                                                                                                                                                             
L203000300QFABRICATED                                                                                                                                                                                                                                                                                                           
L203400100PKNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE    KAFO pla sin up w/wo k/a cus38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L203400200QMOTION KNEE, MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION                                                                                                                                                                                                                                            
L203400300QANKLE, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                             
L203500100PKNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, STATIC (PEDIATRIC SIZE), WITHOUT FREE   KAFO plastic pediatric size 38      A                                                                                                     C                          D1F P       1998010120050101        N                           
L203500200QMOTION ANKLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                         
L203600100PKNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, DOUBLE UPRIGHT, WITH OR WITHOUT FREE    Kafo plas doub free knee mol38      A                                                                                                     C                          D1F P       1988010120060101        C                           
L203600200QMOTION KNEE, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED                                                                                                                                                                                                                                                    
L203700100PKNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE    Kafo plas sing free knee mol38      A                                                                                                     C                          D1F P       1989010120060101        C                           
L203700200QMOTION KNEE, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED                                                                                                                                                                                                                                                    
L203800100PKNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, WITH OR WITHOUT FREE MOTION KNEE,       Kafo w/o joint multi-axis an38      A                                                                                                     C                          D1F P       1989010120060101        C                           
L203800200QMULTI-AXIS ANKLE,  CUSTOM FABRICATED                                                                                                                                                                                                                                                                                 
L203900100PKNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, POLY-AXIAL HINGE,       KAFO,plstic,medlat rotat con38      A                                                                                                     C                          D1F P       199701012006010120051231D                           
L203900200QMEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM                                                                                                                                                                                                                                           
L203900300QFABRICATED                                                                                                                                                                                                                                                                                                           
L204000100PHIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL ROTATION STRAPS,       Hkafo torsion bil rot straps38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L204000200QPELVIC BAND/BELT, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                  
L205000100PHIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, HIP    Hkafo torsion cable hip pelv38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L205000200QJOINT, PELVIC BAND/BELT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                           
L206000100PHIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, BALL   Hkafo torsion ball bearing j38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L206000200QBEARING HIP JOINT, PELVIC BAND/ BELT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                              
L207000100PHIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL ROTATION STRAPS,      Hkafo torsion unilat rot str38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L207000200QPELVIC BAND/BELT, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                  
L208000100PHIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, HIP    Hkafo unilat torsion cable  38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L208000200QJOINT, PELVIC BAND/BELT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                           
L209000100PHIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, BALL   Hkafo unilat torsion ball br38      A                                                                                                     C                          D1F P       1984010120010101        N                           
L209000200QBEARING HIP JOINT, PELVIC BAND/ BELT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                              
L210200100PANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, PLASTER  Afo tibial fx cast plstr mol00      9                                                                                                     I                          D1F P       198801012004010120031231N                           
L210200200QTYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                             
L210400100PANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS,          Afo tib fx cast synthetic mo00      9                                                                                                     I                          D1F P       198801012004010120031231N                           
L210400200QSYNTHETIC TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                   
L210600100PANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS,          Afo tib fx cast plaster mold38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L210600200QTHERMOPLASTIC TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                               
L210800100PANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS,          Afo tib fx cast molded to pt38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L210800200QCUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L211200100PANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SOFT,         Afo tibial fracture soft    38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L211200200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L211400100PANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI-RIGID,   Afo tib fx semi-rigid       38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L211400200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L211600100PANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, RIGID,        Afo tibial fracture rigid   38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L211600200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L212200100PKNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,    Kafo fem fx cast plaster mol00      9                                                                                                     I                          D1F P       198801012004010120031231N                           
L212200200QPLASTER TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                     
L212400100PKNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,    Kafo fem fx cast synthet mol00      9                                                                                                     I                          D1F P       198801012004010120031231N                           
L212400200QSYNTHETIC TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                   
L212600100PKNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,    Kafo fem fx cast thermoplas 38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L212600200QTHERMOPLASTIC TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                               
L212800100PKNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,    Kafo fem fx cast molded to p38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L212800200QCUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L213200100PKAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SOFT, PREFABRICATED,   Kafo femoral fx cast soft   38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L213200200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L213400100PKAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SEMI-RIGID,            Kafo fem fx cast semi-rigid 38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L213400200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L213600100PKAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, RIGID, PREFABRICATED,  Kafo femoral fx cast rigid  38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L213600200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L218000100PADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, PLASTIC SHOE INSERT WITH ANKLE   Plas shoe insert w ank joint38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L218000200QJOINTS                                                                                                                                                                                                                                                                                                               
L218200100PADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, DROP LOCK KNEE JOINT             Drop lock knee              38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L218400100PADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, LIMITED MOTION KNEE JOINT        Limited motion knee joint   38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L218600100PADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, ADJUSTABLE MOTION KNEE JOINT,    Adj motion knee jnt lerman t38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L218600200QLERMAN TYPE                                                                                                                                                                                                                                                                                                          
L218800100PADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, QUADRILATERAL BRIM               Quadrilateral brim          38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L219000100PADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, WAIST BELT                       Waist belt                  38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L219200100PADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, HIP JOINT, PELVIC BAND, THIGH    Pelvic band & belt thigh fla38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L219200200QFLANGE, AND PELVIC BELT                                                                                                                                                                                                                                                                                              
L220000100PADDITION TO LOWER EXTREMITY, LIMITED ANKLE MOTION, EACH JOINT                   Limited ankle motion ea jnt 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L221000100PADDITION TO LOWER EXTREMITY, DORSIFLEXION ASSIST (PLANTAR FLEXION RESIST), EACH Dorsiflexion assist each joi38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L221000200QJOINT                                                                                                                                                                                                                                                                                                                
L222000100PADDITION TO LOWER EXTREMITY, DORSIFLEXION AND PLANTAR FLEXION ASSIST/RESIST,    Dorsi & plantar flex ass/res38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L222000200QEACH JOINT                                                                                                                                                                                                                                                                                                           
L223000100PADDITION TO LOWER EXTREMITY, SPLIT FLAT CALIPER STIRRUPS AND PLATE ATTACHMENT   Split flat caliper stirr & p38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L223200100PADDITION TO LOWER EXTREMITY ORTHOSIS, ROCKER BOTTOM FOR TOTAL CONTACT ANKLE     Rocker bottom, contact AFO  38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L223200200QFOOT ORTHOSIS, FOR CUSTOM FABRICATED ORTHOSIS ONLY                                                                                                                                                                                                                                                                   
L224000100PADDITION TO LOWER EXTREMITY, ROUND CALIPER AND PLATE ATTACHMENT                 Round caliper and plate atta38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L225000100PADDITION  TO LOWER EXTREMITY, FOOT PLATE, MOLDED TO PATIENT MODEL, STIRRUP      Foot plate molded stirrup at38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L225000200QATTACHMENT                                                                                                                                                                                                                                                                                                           
L226000100PADDITION  TO LOWER EXTREMITY, REINFORCED SOLID STIRRUP (SCOTT-CRAIG TYPE)       Reinforced solid stirrup    38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L226500100PADDITION TO LOWER EXTREMITY, LONG TONGUE STIRRUP                                Long tongue stirrup         38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L227000100PADDITION  TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION ('T') STRAP, PADDED/LINED Varus/valgus strap padded/li38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L227000200QOR MALLEOLUS PAD                                                                                                                                                                                                                                                                                                     
L227500100PADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC MODIFICATION,     Plastic mod low ext pad/line38      A                                                                                                     C                          D1F P       1994010119960101        N                           
L227500200QPADDED/LINED                                                                                                                                                                                                                                                                                                         
L228000100PADDITION  TO LOWER EXTREMITY, MOLDED INNER BOOT                                 Molded inner boot           38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L230000100PADDITION  TO LOWER EXTREMITY, ABDUCTION BAR (BILATERAL HIP INVOLVEMENT),        Abduction bar jointed adjust38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L230000200QJOINTED, ADJUSTABLE                                                                                                                                                                                                                                                                                                  
L231000100PADDITION  TO LOWER EXTREMITY, ABDUCTION BAR-STRAIGHT                            Abduction bar-straight      38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L232000100PADDITION TO LOWER EXTREMITY, NON-MOLDED LACER, FOR CUSTOM FABRICATED ORTHOSIS   Non-molded lacer            38      A                                                                                                     C                          D1F P       1986010120050101        N                           
L232000200QONLY                                                                                                                                                                                                                                                                                                                 
L233000100PADDITION TO LOWER EXTREMITY, LACER MOLDED TO PATIENT MODEL, FOR CUSTOM          Lacer molded to patient mode38      A                                                                                                     C                          D1F P       1986010120050101        N                           
L233000200QFABRICATED ORTHOSIS ONLY                                                                                                                                                                                                                                                                                             
L233500100PADDITION  TO LOWER EXTREMITY, ANTERIOR SWING BAND                               Anterior swing band         38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L234000100PADDITION  TO LOWER EXTREMITY, PRE-TIBIAL SHELL, MOLDED TO PATIENT MODEL         Pre-tibial shell molded to p38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L235000100PADDITION  TO LOWER EXTREMITY, PROSTHETIC TYPE, (BK) SOCKET, MOLDED TO PATIENT   Prosthetic type socket molde38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L235000200QMODEL, (USED FOR 'PTB' 'AFO' ORTHOSES)                                                                                                                                                                                                                                                                               
L236000100PADDITION  TO LOWER EXTREMITY, EXTENDED STEEL SHANK                              Extended steel shank        38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L237000100PADDITION TO LOWER EXTREMITY, PATTEN BOTTOM                                      Patten bottom               38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L237500100PADDITION  TO LOWER EXTREMITY, TORSION CONTROL, ANKLE JOINT AND HALF SOLID       Torsion ank & half solid sti38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L237500200QSTIRRUP                                                                                                                                                                                                                                                                                                              
L238000100PADDITION  TO LOWER EXTREMITY, TORSION CONTROL, STRAIGHT KNEE JOINT, EACH JOINT  Torsion straight knee joint 38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L238500100PADDITION  TO LOWER EXTREMITY, STRAIGHT KNEE JOINT, HEAVY DUTY, EACH JOINT       Straight knee joint heavy du38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L238700100PADDITION TO LOWER EXTREMITY, POLYCENTRIC KNEE JOINT, FOR CUSTOM FABRICATED KNEE Add LE poly knee custom KAFO38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L238700200QANKLE FOOT ORTHOSIS, EACH JOINT                                                                                                                                                                                                                                                                                      
L239000100PADDITION  TO LOWER EXTREMITY, OFFSET KNEE JOINT, EACH JOINT                     Offset knee joint each      38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L239500100PADDITION  TO LOWER EXTREMITY, OFFSET KNEE JOINT, HEAVY DUTY, EACH JOINT         Offset knee joint heavy duty38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L239700100PADDITION TO LOWER EXTREMITY ORTHOSIS, SUSPENSION SLEEVE                         Suspension sleeve lower ext 38      A                                                                                                     C                          D1F P       1994010119960101        N                           
L240500100PADDITION TO KNEE JOINT, DROP LOCK, EACH                                         Knee joint drop lock ea jnt 38      A                                                                                                     C                          D1F P       1988010120060101        C                           
L241500100PADDITION TO KNEE LOCK WITH INTEGRATED RELEASE MECHANISM ( BAIL, CABLE, OR       Knee joint cam lock each joi38      A                                                                                                     C                          D1F P       1988010120020101        N                           
L241500200QEQUAL), ANY MATERIAL, EACH JOINT                                                                                                                                                                                                                                                                                     
L242500100PADDITION TO KNEE JOINT, DISC OR DIAL LOCK FOR ADJUSTABLE KNEE FLEXION, EACH     Knee disc/dial lock/adj flex38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L242500200QJOINT                                                                                                                                                                                                                                                                                                                
L243000100PADDITION TO KNEE JOINT, RATCHET LOCK FOR ACTIVE AND PROGRESSIVE KNEE EXTENSION, Knee jnt ratchet lock ea jnt38      A                                                                                                     C                          D1F P       1997010119970101        N                           
L243000200QEACH JOINT                                                                                                                                                                                                                                                                                                           
L243500100PADDITION TO KNEE JOINT, POLYCENTRIC JOINT, EACH JOINT                           Knee joint polycentric joint38      A                                                                                                     C                          D1F P       198801012005010120041231N                           
L249200100PADDITION TO KNEE JOINT, LIFT LOOP FOR DROP LOCK RING                            Knee lift loop drop lock rin38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L250000100PADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, GLUTEAL/ ISCHIAL WEIGHT      Thi/glut/ischia wgt bearing 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L250000200QBEARING, RING                                                                                                                                                                                                                                                                                                        
L251000100PADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM, MOLDED Th/wght bear quad-lat brim m38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L251000200QTO PATIENT MODEL                                                                                                                                                                                                                                                                                                     
L252000100PADDITION  TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM,       Th/wght bear quad-lat brim c38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L252000200QCUSTOM FITTED                                                                                                                                                                                                                                                                                                        
L252500100PADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW   Th/wght bear nar m-l brim mo38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L252500200QM-L BRIM MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                     
L252600100PADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW   Th/wght bear nar m-l brim cu38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L252600200QM-L BRIM, CUSTOM FITTED                                                                                                                                                                                                                                                                                              
L253000100PADDITION  TO LOWER EXTREMITY, THIGH-WEIGHT BEARING, LACER, NON-MOLDED           Thigh/wght bear lacer non-mo38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L254000100PADDITION  TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, LACER, MOLDED TO PATIENT    Thigh/wght bear lacer molded38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L254000200QMODEL                                                                                                                                                                                                                                                                                                                
L255000100PADDITION  TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, HIGH ROLL CUFF              Thigh/wght bear high roll cu38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L257000100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE TWO         Hip clevis type 2 posit jnt 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L257000200QPOSITION JOINT, EACH                                                                                                                                                                                                                                                                                                 
L258000100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PELVIC SLING                       Pelvic control pelvic sling 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L260000100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE, OR THRUST  Hip clevis/thrust bearing fr38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L260000200QBEARING, FREE, EACH                                                                                                                                                                                                                                                                                                  
L261000100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS OR THRUST        Hip clevis/thrust bearing lo38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L261000200QBEARING, LOCK, EACH                                                                                                                                                                                                                                                                                                  
L262000100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, HEAVY DUTY, EACH        Pelvic control hip heavy dut38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L262200100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION, EACHHip joint adjustable flexion38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L262400100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION,     Hip adj flex ext abduct cont38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L262400200QEXTENSION, ABDUCTION CONTROL, EACH                                                                                                                                                                                                                                                                                   
L262700100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PLASTIC, MOLDED TO PATIENT MODEL,  Plastic mold recipro hip & c38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L262700200QRECIPROCATING HIP JOINT AND CABLES                                                                                                                                                                                                                                                                                   
L262800100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, METAL FRAME, RECIPROCATING HIP     Metal frame recipro hip & ca38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L262800200QJOINT AND CABLES                                                                                                                                                                                                                                                                                                     
L263000100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, UNILATERAL          Pelvic control band & belt u38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L264000100PADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, BILATERAL           Pelvic control band & belt b38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L265000100PADDITION TO LOWER EXTREMITY, PELVIC AND THORACIC CONTROL, GLUTEAL PAD, EACH     Pelv & thor control gluteal 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L266000100PADDITION TO LOWER EXTREMITY, THORACIC CONTROL, THORACIC BAND                    Thoracic control thoracic ba38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L267000100PADDITION TO LOWER EXTREMITY, THORACIC CONTROL, PARASPINAL UPRIGHTS              Thorac cont paraspinal uprig38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L268000100PADDITION TO LOWER EXTREMITY, THORACIC CONTROL, LATERAL SUPPORT UPRIGHTS         Thorac cont lat support upri38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L275000100PADDITION TO LOWER EXTREMITY ORTHOSIS, PLATING CHROME OR NICKEL, PER BAR         Plating chrome/nickel pr bar38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L275500100PADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRENGTH, LIGHTWEIGHT MATERIAL, ALL  Carbon graphite lamination  38      A                                                                                                     C                          D1F P       1997010120050101        N                           
L275500200QHYBRID LAMINATION/PREPREG COMPOSITE, PER SEGMENT, FOR CUSTOM FABRICATED                                                                                                                                                                                                                                              
L275500300QORTHOSIS ONLY                                                                                                                                                                                                                                                                                                        
L276000100PADDITION TO LOWER EXTREMITY ORTHOSIS, EXTENSION, PER EXTENSION, PER BAR (FOR    Extension per extension per 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L276000200QLINEAL ADJUSTMENT FOR GROWTH)                                                                                                                                                                                                                                                                                        
L276800100PORTHOTIC SIDE BAR DISCONNECT DEVICE, PER BAR                                    Ortho sidebar disconnect    38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L277000100PADDITION TO LOWER EXTREMITY ORTHOSIS, ANY MATERIAL - PER BAR OR JOINT           Low ext orthosis per bar/jnt38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L278000100PADDITION TO LOWER EXTREMITY ORTHOSIS, NON-CORROSIVE FINISH, PER BAR             Non-corrosive finish        38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L278500100PADDITION TO LOWER EXTREMITY ORTHOSIS, DROP LOCK RETAINER, EACH                  Drop lock retainer each     38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L279500100PADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, FULL KNEECAP                Knee control full kneecap   38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L280000100PADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, KNEE CAP, MEDIAL OR LATERAL Knee cap medial or lateral p38      A                                                                                                     C                          D1F P       1988010120050101        N                           
L280000200QPULL, FOR USE WITH CUSTOM FABRICATED ORTHOSIS ONLY                                                                                                                                                                                                                                                                   
L281000100PADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, CONDYLAR PAD                Knee control condylar pad   38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L282000100PADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, BELOW  Soft interface below knee se38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L282000200QKNEE SECTION                                                                                                                                                                                                                                                                                                         
L283000100PADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, ABOVE  Soft interface above knee se38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L283000200QKNEE SECTION                                                                                                                                                                                                                                                                                                         
L284000100PADDITION TO LOWER EXTREMITY ORTHOSIS, TIBIAL LENGTH SOCK, FRACTURE OR EQUAL,    Tibial length sock fx or equ38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L284000200QEACH                                                                                                                                                                                                                                                                                                                 
L285000100PADDITION TO LOWER EXTREMITY ORTHOSIS, FEMORAL LENGTH SOCK, FRACTURE OR EQUAL,   Femoral lgth sock fx or equa38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L285000200QEACH                                                                                                                                                                                                                                                                                                                 
L286000100PADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION Torsion mechanism knee/ankle00      9                                                                                                     C                          D1F P       1995010119980312        N                           
L286000200QSTYLE MECHANISM, EACH                                                                                                                                                                                                                                                                                                
L299900100PLOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED                               Lower extremity orthosis NOS46      A                                                                                                     C                          D1F P       1982010119980101        N                           
L300000100PFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, 'UCB' TYPE, BERKELEY SHELL,   Ft insert ucb berkeley shell00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L300000200QEACH                                                                                                                                                                                                                                                                                                                 
L300100100PFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SPENCO, EACH                  Foot insert remov molded spe00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L300200100PFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, PLASTAZOTE OR EQUAL, EACH     Foot insert plastazote or eq00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L300300100PFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SILICONE GEL, EACH            Foot insert silicone gel eac00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L301000100PFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL ARCH SUPPORT,    Foot longitudinal arch suppo00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L301000200QEACH                                                                                                                                                                                                                                                                                                                 
L302000100PFOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL/ METATARSAL      Foot longitud/metatarsal sup00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L302000200QSUPPORT, EACH                                                                                                                                                                                                                                                                                                        
L303000100PFOOT, INSERT, REMOVABLE, FORMED TO PATIENT FOOT, EACH                           Foot arch support remov prem00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L303100100PFOOT, INSERT/PLATE, REMOVABLE, ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH       Foot lamin/prepreg composite00      9                                                                                                     C                          D1F P       2004010120050101        F                           
L303100200QSTRENGTH, LIGHTWEIGHT MATERIAL, ALL HYBRID LAMINATION/PREPREG COMPOSITE, EACH                                                                                                                                                                                                                                        
L304000100PFOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL, EACH                    Ft arch suprt premold longit00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L305000100PFOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, METATARSAL, EACH                      Foot arch supp premold metat00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L306000100PFOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL/ METATARSAL, EACH        Foot arch supp longitud/meta00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L307000100PFOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL, EACH          Arch suprt att to sho longit00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L308000100PFOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, METATARSAL, EACH            Arch supp att to shoe metata00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L309000100PFOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL/METATARSAL,    Arch supp att to shoe long/m00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L309000200QEACH                                                                                                                                                                                                                                                                                                                 
L310000100PHALLUS-VALGUS NIGHT DYNAMIC SPLINT                                              Hallus-valgus nght dynamic s00      9                  2323                                                                               D                          D1F P       1985010119970101        N                           
L314000100PFOOT, ABDUCTION ROTATION BAR, INCLUDING SHOES                                   Abduction rotation bar shoe 00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L315000100PFOOT, ABDUCTION ROTATATION BAR, WITHOUT SHOES                                   Abduct rotation bar w/o shoe00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L316000100PFOOT, ADJUSTABLE SHOE-STYLED POSITIONING DEVICE                                 Shoe styled positioning dev 00      9                                                                                                     C                          D1F P       1986010119950101        N                           
L317000100PFOOT, PLASTIC, SILICONE OR EQUAL,  HEEL STABILIZER, EACH                        Foot plastic heel stabilizer00      9                  2323                                                                               D                          D1F P       1984010120060101        C                           
L320100100PORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, INFANT                      Oxford w supinat/pronat inf 00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L320200100PORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, CHILD                       Oxford w/ supinat/pronator c00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L320300100PORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, JUNIOR                      Oxford w/ supinator/pronator00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L320400100PORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, INFANT                     Hightop w/ supp/pronator inf00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L320600100PORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, CHILD                      Hightop w/ supp/pronator chi00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L320700100PORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, JUNIOR                     Hightop w/ supp/pronator jun00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L320800100PSURGICAL BOOT, EACH, INFANT                                                     Surgical boot each infant   00      9                  2079                                                                               D                          D1F P       1984010119960101        N                           
L320900100PSURGICAL BOOT, EACH, CHILD                                                      Surgical boot each child    00      9                  2079                                                                               D                          D1F P       1984010119960101        N                           
L321100100PSURGICAL BOOT, EACH, JUNIOR                                                     Surgical boot each junior   00      9                  2079                                                                               D                          D1F P       1984010119960101        N                           
L321200100PBENESCH BOOT, PAIR, INFANT                                                      Benesch boot pair infant    00      9                  2079                                                                               D                          D1F P       1984010119960101        N                           
L321300100PBENESCH BOOT, PAIR, CHILD                                                       Benesch boot pair child     00      9                  2079                                                                               D                          D1F P       1984010119960101        N                           
L321400100PBENESCH BOOT, PAIR, JUNIOR                                                      Benesch boot pair junior    00      9                  2079                                                                               D                          D1F P       1984010119960101        N                           
L321500100PORTHOPEDIC FOOTWEAR, LADIES SHOE, OXFORD, EACH                                  Orthopedic ftwear ladies oxf00      9                                          1862A8                                                     S                          D1F P       1984010120060101        C                           
L321600100PORTHOPEDIC FOOTWEAR, LADIES SHOE, DEPTH INLAY, EACH                             Orthoped ladies shoes dpth i00      9                                          1862A8                                                     S                          D1F P       1984010120060101        C                           
L321700100PORTHOPEDIC FOOTWEAR, LADIES SHOE, HIGHTOP, DEPTH INLAY, EACH                    Ladies shoes hightop depth i00      9                                          1862A8                                                     S                          D1F P       1984010120060101        C                           
L321800100PORTHOPEDIC FOOTWEAR, LADIES SURGICAL BOOT, EACH                                 Ladies surgical boot each   00      9                  2323                                                      L3260                    D                          D1F P       198401012003010120021231N                           
L321900100PORTHOPEDIC FOOTWEAR, MENS SHOE, OXFORD, EACH                                    Orthopedic mens shoes oxford00      9                                          1862A8                                                     S                          D1F P       1984010120060101        C                           
L322100100PORTHOPEDIC FOOTWEAR, MENS SHOE, DEPTH INLAY, EACH                               Orthopedic mens shoes dpth i00      9                                          1862A8                                                     S                          D1F P       1984010120060101        C                           
L322200100PORTHOPEDIC FOOTWEAR, MENS SHOE, HIGHTOP, DEPTH INLAY, EACH                      Mens shoes hightop depth inl00      9                                          1862A8                                                     S                          D1F P       1984010120060101        C                           
L322300100PORTHOPEDIC FOOTWEAR, MENS SURGICAL BOOT, EACH                                   Mens surgical boot each     00      9                  2323                                                      L3260                    D                          D1F P       198401012003010120021231N                           
L322400100PORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE  Woman's shoe oxford brace   38      A                  2323D                                                                              D                          D1F P       1995010119950101        N                           
L322400200Q(ORTHOSIS)                                                                                                                                                                                                                                                                                                           
L322500100PORTHOPEDIC FOOTWEAR, MAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE    Man's shoe oxford brace     38      A                  2323D                                                                              D                          D1F P       1995010119950101        N                           
L322500200Q(ORTHOSIS)                                                                                                                                                                                                                                                                                                           
L323000100PORTHOPEDIC FOOTWEAR, CUSTOM SHOE, DEPTH INLAY, EACH                             Custom shoes depth inlay    00      9                  2323                                                                               D                          D1F P       1984010120060101        C                           
L325000100PORTHOPEDIC FOOTWEAR, CUSTOM MOLDED SHOE, REMOVABLE INNER MOLD, PROSTHETIC SHOE, Custom mold shoe remov prost00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L325000200QEACH                                                                                                                                                                                                                                                                                                                 
L325100100PFOOT, SHOE MOLDED TO PATIENT MODEL, SILICONE SHOE, EACH                         Shoe molded to pt silicone s00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L325200100PFOOT, SHOE MOLDED TO PATIENT MODEL, PLASTAZOTE (OR SIMILAR), CUSTOM FABRICATED, Shoe molded plastazote cust 00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L325200200QEACH                                                                                                                                                                                                                                                                                                                 
L325300100PFOOT, MOLDED SHOE PLASTAZOTE (OR SIMILAR) CUSTOM FITTED, EACH                   Shoe molded plastazote cust 00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L325400100PNON-STANDARD SIZE OR WIDTH                                                      Orth foot non-stndard size/w00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L325500100PNON-STANDARD SIZE OR LENGTH                                                     Orth foot non-standard size/00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L325700100PORTHOPEDIC FOOTWEAR, ADDITIONAL CHARGE FOR SPLIT SIZE                           Orth foot add charge split s00      9                  2323                                                                               D                          D1F P       1988010119970101        N                           
L326000100PSURGICAL BOOT/SHOE, EACH                                                        Ambulatory surgical boot eac00      9                  2079                                                                               D                          D1F P       1984010120030101        N                           
L326500100PPLASTAZOTE SANDAL, EACH                                                         Plastazote sandal each      00      9                                                                                                     C                          D1F P       1984010119960101        N                           
L330000100PLIFT, ELEVATION, HEEL, TAPERED TO METATARSALS, PER INCH                         Sho lift taper to metatarsal00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L331000100PLIFT, ELEVATION, HEEL AND SOLE, NEOPRENE, PER INCH                              Shoe lift elev heel/sole neo00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L332000100PLIFT, ELEVATION, HEEL AND SOLE, CORK, PER INCH                                  Shoe lift elev heel/sole cor00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L333000100PLIFT, ELEVATION, METAL EXTENSION (SKATE)                                        Lifts elevation metal extens00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L333200100PLIFT, ELEVATION, INSIDE SHOE, TAPERED, UP TO ONE-HALF INCH                      Shoe lifts tapered to one-ha00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L333400100PLIFT, ELEVATION, HEEL, PER INCH                                                 Shoe lifts elevation heel /i00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L334000100PHEEL WEDGE, SACH                                                                Shoe wedge sach             00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L335000100PHEEL WEDGE                                                                      Shoe heel wedge             00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L336000100PSOLE WEDGE, OUTSIDE SOLE                                                        Shoe sole wedge outside sole00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L337000100PSOLE WEDGE, BETWEEN SOLE                                                        Shoe sole wedge between sole00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L338000100PCLUBFOOT WEDGE                                                                  Shoe clubfoot wedge         00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L339000100POUTFLARE WEDGE                                                                  Shoe outflare wedge         00      9                  2323                                                                               D                          D1F P       1982010119970101        N                           
L340000100PMETATARSAL BAR WEDGE, ROCKER                                                    Shoe metatarsal bar wedge ro00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L341000100PMETATARSAL BAR WEDGE, BETWEEN SOLE                                              Shoe metatarsal bar between 00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L342000100PFULL SOLE AND HEEL WEDGE, BETWEEN SOLE                                          Full sole/heel wedge btween 00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L343000100PHEEL, COUNTER, PLASTIC REINFORCED                                               Sho heel count plast reinfor00      9                  2323                                                                               D                          D1F P       1985010119970101        N                           
L344000100PHEEL, COUNTER, LEATHER REINFORCED                                               Heel leather reinforced     00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L345000100PHEEL, SACH CUSHION TYPE                                                         Shoe heel sach cushion type 00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L345500100PHEEL, NEW LEATHER, STANDARD                                                     Shoe heel new leather standa00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L346000100PHEEL, NEW RUBBER, STANDARD                                                      Shoe heel new rubber standar00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L346500100PHEEL, THOMAS WITH WEDGE                                                         Shoe heel thomas with wedge 00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L347000100PHEEL, THOMAS EXTENDED TO BALL                                                   Shoe heel thomas extend to b00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L348000100PHEEL, PAD AND DEPRESSION FOR SPUR                                               Shoe heel pad & depress for 00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L348500100PHEEL, PAD, REMOVABLE FOR SPUR                                                   Shoe heel pad removable for 00      9                  2323                                                                               D                          D1F P       1984010119970101        N                           
L350000100PORTHOPEDIC SHOE ADDITION, INSOLE, LEATHER                                       Ortho shoe add leather insol00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L351000100PORTHOPEDIC SHOE ADDITION, INSOLE, RUBBER                                        Orthopedic shoe add rub insl00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L352000100PORTHOPEDIC SHOE ADDITION, INSOLE, FELT COVERED WITH LEATHER                     O shoe add felt w leath insl00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L353000100PORTHOPEDIC SHOE ADDITION, SOLE, HALF                                            Ortho shoe add half sole    00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L354000100PORTHOPEDIC SHOE ADDITION, SOLE, FULL                                            Ortho shoe add full sole    00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L355000100PORTHOPEDIC SHOE ADDITION, TOE TAP STANDARD                                      O shoe add standard toe tap 00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L356000100PORTHOPEDIC SHOE ADDITION, TOE TAP, HORSESHOE                                    O shoe add horseshoe toe tap00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L357000100PORTHOPEDIC SHOE ADDITION, SPECIAL EXTENSION TO INSTEP (LEATHER WITH EYELETS)    O shoe add instep extension 00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L358000100PORTHOPEDIC SHOE ADDITION, CONVERT INSTEP TO VELCRO CLOSURE                      O shoe add instep velcro clo00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L359000100PORTHOPEDIC SHOE ADDITION, CONVERT FIRM SHOE COUNTER TO SOFT COUNTER             O shoe convert to sof counte00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L359500100PORTHOPEDIC SHOE ADDITION, MARCH BAR                                             Ortho shoe add march bar    00      9                  2323                                                                               D                          D1F P       1986010119990101        N                           
L360000100PTRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, EXISTING      Trans shoe calip plate exist00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L361000100PTRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, NEW           Trans shoe caliper plate new00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L362000100PTRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, EXISTING      Trans shoe solid stirrup exi00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L363000100PTRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, NEW           Trans shoe solid stirrup new00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L364000100PTRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, DENNIS BROWNE SPLINT         Shoe dennis browne splint bo00      9                  2323                                                                               D                          D1F P       1986010119970101        N                           
L364000200Q(RIVETON), BOTH SHOES                                                                                                                                                                                                                                                                                                
L364900100PORTHOPEDIC SHOE, MODIFICATION, ADDITION OR TRANSFER, NOT OTHERWISE SPECIFIED    Orthopedic shoe modifica NOS00      9                  2323                                                                               D                          D1F P       1982010119990101        N                           
L365000100PSHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, PREFABRICATED,  Shlder fig 8 abduct restrain38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L365000200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L365100100PSHOULDER ORTHOSIS, SINGLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING    Prefab shoulder orthosis    38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L365100200QAND ADJUSTMENT (E.G. NEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                
L365200100PSHOULDER ORTHOSIS, DOUBLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING    Prefab dbl shoulder orthosis38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L365200200QAND ADJUSTMENT (E.G. NEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                
L366000100PSHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND      Abduct restrainer canvas&web38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L366000200QWEBBING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                              
L367000100PSHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, Acromio/clavicular canvas&we38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L367000200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L367100100PSHOULDER ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT        SO cap design w/o jnts CF   38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L367100200QINTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                
L367200100PSHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT  SO airplane w/o jnts CF     38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L367200200QAND SUPPORT BAR, WITHOUT JOINTS, MAY INLCUDE SOFT INTERFACE, STRAPS, CUSTOM                                                                                                                                                                                                                                          
L367200300QFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L367300100PSHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT  SO airplane w/joint CF      38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L367300200QAND SUPPORT BAR, INCLUDES NONTORSION JOINT/TURNBUCKLE, MAY INCLUDE SOFT                                                                                                                                                                                                                                              
L367300300QINTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                
L367500100PSHOULDER ORTHOSIS, VEST TYPE ABDUCTION RESTRAINER, CANVAS WEBBING TYPE OR       Canvas vest SO              38      A                                                                                                     C                          D1F P       1999010120010101        N                           
L367500200QEQUAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                
L367700100PSHOULDER ORTHOSIS, HARD PLASTIC, SHOULDER STABILIZER, PRE-FABRICATED, INCLUDES  SO hard plastic stabilizer  00      9                  2130                                                                               D                          Z2  P       2002010120020101        N                           
L367700200QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L370000100PELBOW ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND         Elbow orthoses elas w stays 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L370000200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L370100100PELBOW ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G.   Prefab elbow orthosis       38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L370100200QNEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                                     
L370200100PELBOW ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM      EO w/o joints CF            38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L370200200QFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L371000100PELBOW ORTHOSIS, ELASTIC WITH METAL JOINTS, PREFABRICATED, INCLUDES FITTING AND  Elbow elastic with metal joi38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L371000200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L372000100PELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, FREE MOTION,             Forearm/arm cuffs free motio38      A                                                                                                     C                          D1F P       1984010120010101        N                           
L372000200QCUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L373000100PELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, EXTENSION/ FLEXION       Forearm/arm cuffs ext/flex a38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L373000200QASSIST, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                            
L374000100PELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, ADJUSTABLE POSITION LOCK Cuffs adj lock w/ active con38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L374000200QWITH ACTIVE CONTROL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                               
L376000100PELBOW ORTHOSIS, WITH ADJUSTABLE POSITION LOCKING JOINT(S), PREFABRICATED,       EO withjoint, Prefabricated 38      A                                                                                                     C                          D1F P       2001010120010101        N                           
L376000200QINCLUDES FITTING AND ADJUSTMENTS, ANY TYPE                                                                                                                                                                                                                                                                           
L376200100PELBOW ORTHOSIS, RIGID, WITHOUT JOINTS, INCLUDES SOFT INTERFACE MATERIAL,        Rigid EO wo joints          38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L376200200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L376300100PELBOW WRIST HAND ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE,   EWHO rigid w/o jnts CF      38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L376300200QSTRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L376400100PELBOW WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC      EWHO w/joint(s) CF          38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L376400200QBANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED,                                                                                                                                                                                                                                           
L376400300QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L376500100PELBOW WRIST HAND FINGER ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT       EWHFO rigid w/o jnts CF     38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L376500200QINTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                
L376600100PELBOW WRIST HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS,       EWHFO w/joint(s) CF         38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L376600200QELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                                                                                                                                                                                                                                               
L376600300QFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L380000100PWRIST HAND FINGER ORTHOSIS, SHORT OPPONENS, NO ATTACHMENTS, CUSTOM-FABRICATED   Whfo short opponen no attach38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L380500100PWRIST HAND FINGER ORTHOSIS, LONG OPPONENS, NO ATTACHMENT, CUSTOM-FABRICATED     Whfo long opponens no attach38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L380700100PWRIST HAND FINGER ORTHOSIS, WITHOUT JOINT(S), PREFABRICATED, INCLUDES FITTING   WHFO,no joint, prefabricated38      A                                                                                                     C                          D1F P       2000010120010101        N                           
L380700200QAND ADJUSTMENTS, ANY TYPE                                                                                                                                                                                                                                                                                            
L381000100PWHFO, ADDITION  TO SHORT AND LONG OPPONENS, THUMB ABDUCTION ('C') BAR           Whfo thumb abduction bar    38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L381500100PWHFO, ADDITION  TO SHORT AND LONG OPPONENS, SECOND M.P. ABDUCTION ASSIST        Whfo second m.p. abduction a38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L382000100PWHFO, ADDITION TO SHORT AND LONG OPPONENS, I.P. EXTENSION ASSIST, WITH M.P.     Whfo ip ext asst w/ mp ext s38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L382000200QEXTENSION STOP                                                                                                                                                                                                                                                                                                       
L382500100PWHFO, ADDITION  TO SHORT AND LONG OPPONENS, M.P. EXTENSION STOP                 Whfo m.p. extension stop    38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L383000100PWHFO, ADDITION  TO SHORT AND LONG OPPONENS, M.P. EXTENSION ASSIST               Whfo m.p. extension assist  38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L383500100PWHFO, ADDITION  TO SHORT AND LONG OPPONENS, M.P. SPRING EXTENSION ASSIST        Whfo m.p. spring extension a38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L384000100PWHFO, ADDITION  TO SHORT AND LONG OPPONENS, SPRING SWIVEL THUMB                 Whfo spring swivel thumb    38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L384500100PWHFO, ADDITION  TO SHORT AND LONG OPPONENS, THUMB I.P. EXTENSION ASSIST, WITH   Whfo thumb ip ext ass w/ mp 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L384500200QM.P. STOP                                                                                                                                                                                                                                                                                                            
L385000100PWHO, ADDITION TO SHORT AND LONG OPPONENS, ACTION WRIST, WITH DORSIFLEXION ASSISTAction wrist w/ dorsiflex as38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L385500100PWHFO, ADDITION  TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL     Whfo adj m.p. flexion contro38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L386000100PWHFO, ADDITION  TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL AND Whfo adj m.p. flex ctrl & i.38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L386000200QI.P.                                                                                                                                                                                                                                                                                                                 
L389000100PADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE        Torsion mechanism wrist/elbo00      9                                                                                                     C                          D1F P       1995010119980312        N                           
L389000200QTORSION STYLE MECHANISM, EACH                                                                                                                                                                                                                                                                                        
L390000100PWRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/   Hinge extension/flex wrist/f38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L390000200QFLEXION, FINGER FLEXION/EXTENSION, WRIST OR FINGER DRIVEN, CUSTOM-FABRICATED                                                                                                                                                                                                                                         
L390100100PWRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/   Hinge ext/flex wrist finger 38      A                                                                                                     C                          D1F P       1984010120010101        N                           
L390100200QFLEXION, FINGER FLEXION/EXTENSION, CABLE DRIVEN, CUSTOM-FABRICATED                                                                                                                                                                                                                                                   
L390200100PWRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, COMPRESSED GAS, CUSTOM-FABRICATED Whfo ext power compress gas 00      9                                                                                                     I                          D1F P       1985010120040101        N                           
L390400100PWRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, ELECTRIC, CUSTOM-FABRICATED       Whfo electric custom fitted 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L390500100PWRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS,     WHO w/nontorsion jnt(s) CF  38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L390500200QTURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES                                                                                                                                                                                                                                         
L390500300QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L390600100PWRIST HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM WHO w/o joints CF           38      A                                                                                                     C                          D1F P       1986010120060101        C                           
L390600200QFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L390700100PWRIST HAND FINGER ORTHOSIS, WRIST GAUNTLET WITH THUMB SPICA, CUSTOM-FABRICATED  Whfo wrst gauntlt thmb spica38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L390800100PWRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED,               Wrist cock-up non-molded    38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L390800200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L390900100PWRIST ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G.   Prefab wrist orthosis       38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L390900200QNEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                                     
L391000100PWRIST HAND FINGER ORTHOSIS, SWANSON DESIGN, PREFABRICATED, INCLUDES FITTING AND Whfo swanson design         38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L391000200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L391100100PWRIST HAND FINGER ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND        Prefab hand finger orthosis 38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L391100200QADJUSTMENT (E.G. NEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                    
L391200100PHAND FINGER ORTHOSIS, FLEXION GLOVE WITH ELASTIC FINGER CONTROL, PREFABRICATED, Flex glove w/elastic finger 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L391200200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L391300100PHAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS,       HFO w/o joints CF           38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L391300200QCUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                   
L391400100PWRIST HAND ORTHOSIS, WRIST EXTENSION COCK-UP, PREFABRICATED, INCLUDES           WHO wrist extension cock-up 38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L391400200QFITTING/ADJUSTMENT                                                                                                                                                                                                                                                                                                   
L391600100PWRIST HAND FINGER ORTHOSIS, WRIST EXTENSION COCK-UP WITH OUTRIGGER,             Whfo wrist extens w/ outrigg38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L391600200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L391700100PHAND ORTHOSIS, METACARPAL FRACTURE ORTHOSIS, PREFABRICATED, INCLUDES FITTING    Prefab metacarpl fx orthosis38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L391700200QAND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L391800100PHAND FINGER ORTHOSIS, KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND       HFO knuckle bender          38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L391800200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L391900100PHAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM       HO w/o joints CF            38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L391900200QFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L392000100PHAND FINGER ORTHOSIS, KNUCKLE BENDER WITH OUTRIGGER, PREFABRICATED, INCLUDES    Knuckle bender with outrigge38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L392000200QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L392100100PHAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS,    HFO w/joint(s) CF           38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L392100200QTURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES                                                                                                                                                                                                                                         
L392100300QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L392200100PHAND FINGER ORTHOSIS, KNUCKLE BENDER, TWO SEGMENT TO FLEX JOINTS,               Knuckle bend 2 seg to flex j38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L392200200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L392300100PHAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS,       HFO w/o joints PF           38      A                                                                                                     C                          D1F P       2001010120060101        C                           
L392300200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L392400100PWRIST HAND FINGER ORTHOSIS, OPPENHEIMER, PREFABRICATED, INCLUDES FITTING AND    Oppenheimer                 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L392400200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L392600100PWRIST HAND FINGER ORTHOSIS, THOMAS SUSPENSION, PREFABRICATED, INCLUDES FITTING  Thomas suspension           38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L392600200QAND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L392800100PHAND FINGER ORTHOSIS, FINGER EXTENSION, WITH CLOCK SPRING, PREFABRICATED,       Finger extension w/ clock sp38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L392800200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L393000100PWRIST HAND FINGER ORTHOSIS, FINGER EXTENSION, WITH WRIST SUPPORT,               Finger extension with wrist 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L393000200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L393200100PFINGER ORTHOSIS, SAFETY PIN, SPRING WIRE, PREFABRICATED, INCLUDES FITTING AND   Safety pin spring wire      38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L393200200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L393300100PFINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED, FO w/o joints CF            38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L393300200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L393400100PFINGER ORTHOSIS, SAFETY PIN, MODIFIED, PREFABRICATED, INCLUDES FITTING AND      Safety pin modified         38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L393400200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L393500100PFINGER ORTHOSIS, NONTORSION JOINT, MAY INCLUDE SOFT INTERFACE, CUSTOM           FO nontorsion joint CF      38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L393500200QFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L393600100PWRIST HAND FINGER ORTHOSIS, PALMER, PREFABRICATED, INCLUDES FITTING AND         Palmer                      38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L393600200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L393800100PWRIST HAND FINGER ORTHOSIS, DORSAL WRIST, PREFABRICATED, INCLUDES FITTING AND   Dorsal wrist                38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L393800200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L394000100PWRIST HAND FINGER ORTHOSIS, DORSAL WRIST, WITH OUTRIGGER ATTACHMENT,            Dorsal wrist w/ outrigger at38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L394000200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L394200100PHAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING   Reverse knuckle bender      38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L394200200QAND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L394400100PHAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, WITH OUTRIGGER, PREFABRICATED,    Reverse knuckle bend w/ outr38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L394400200QINCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L394600100PHAND FINGER ORTHOSIS, COMPOSITE ELASTIC, PREFABRICATED, INCLUDES FITTING AND    HFO composite elastic       38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L394600200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L394800100PFINGER ORTHOSIS, FINGER KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND     Finger knuckle bender       38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L394800200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L395000100PWRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH KNUCKLE BENDER AND    Oppenheimer w/ knuckle bend 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L395000200QTWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                      
L395200100PWRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH REVERSE KNUCKLE AND   Oppenheimer w/ rev knuckle 238      A                                                                                                     C                          D1F P       1982010120010101        N                           
L395200200QTWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                      
L395400100PHAND FINGER ORTHOSIS, SPREADING HAND, PREFABRICATED, INCLUDES FITTING AND       Spreading hand              38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L395400200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L395600100PADDITION OF JOINT TO UPPER EXTREMITY ORTHOSIS, ANY MATERIAL; PER JOINT          Add joint upper ext orthosis38      A                                                                                                     C                          D1F P       1997010119970101        N                           
L396000100PSHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, AIRPLANE DESIGN,     Sewho airplan desig abdu pos38      A                                                                                                     C                          D1F P       1986010120010101        N                           
L396000200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L396100100PSHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY    SEWHO cap design w/o jnts CF38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L396100200QINCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                              
L396100300QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L396200100PSHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, ERBS PALSEY DESIGN,  Sewho erbs palsey design abd38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L396200200QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L396300100PSHOULDER ELBOW WRIST HAND ORTHOSIS, MOLDED SHOULDER, ARM, FOREARM AND WRIST,    Molded w/ articulating elbow38      A                                                                                                     C                          D1F P       198801012006010120051231D                           
L396300200QWITH ARTICULATING  ELBOW JOINT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                    
L396400100PSHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED,   Seo mobile arm sup att to wc32      A                                                                                                     C                          D1D APR     1986010120010101        N                           
L396400200QADJUSTABLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L396500100PSHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED,   Arm supp att to wc rancho ty32      A                                                                                                     C                          D1D APR     1984010120010101        N                           
L396500200QADJUSTABLE RANCHO TYPE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                               
L396600100PSHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED,   Mobile arm supports reclinin32      A                                                                                                     C                          D1D APR     1986010120010101        N                           
L396600200QRECLINING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                            
L396700100PSHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN),    SEWHO airplane w/o jnts CF  38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L396700200QTHORACIC COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE,                                                                                                                                                                                                                                      
L396700300QSTRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L396800100PSHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED,   Friction dampening arm supp 32      A                                                                                                     C                          D1D APR     1986010120010101        N                           
L396800200QFRICTION ARM SUPPORT (FRICTION DAMPENING TO PROXIMAL AND DISTAL JOINTS),                                                                                                                                                                                                                                             
L396800300QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L396900100PSHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT, MONOSUSPENSION ARM AND HAND        Monosuspension arm/hand supp32      A                                                                                                     C                          D1D APR     1988010120010101        N                           
L396900200QSUPPORT, OVERHEAD ELBOW FOREARM HAND SLING SUPPORT, YOKE TYPE SUSPENSION                                                                                                                                                                                                                                             
L396900300QSUPPORT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                              
L397000100PSEO, ADDITION TO MOBILE ARM SUPPORT, ELEVATING PROXIMAL ARM                     Elevat proximal arm support 32      A                                                                                                     C                          D1D APR     1986010119980101        N                           
L397100100PSHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE OR MORE   SEWHO cap design w/jnt(s) CF38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L397100200QNONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE,                                                                                                                                                                                                                                           
L397100300QSTRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L397200100PSEO, ADDITION TO MOBILE ARM SUPPORT, OFFSET OR LATERAL ROCKER ARM WITH ELASTIC  Offset/lat rocker arm w/ ela32      A                                                                                                     C                          D1D APR     1986010119980101        N                           
L397200200QBALANCE CONTROL                                                                                                                                                                                                                                                                                                      
L397300100PSHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN),    SEWHO airplane w/jnt(s) CF  38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L397300200QTHORACIC COMPONENT AND SUPPORT BAR, INCLUDES ONE OR MORE NONTORSION JOINTS,                                                                                                                                                                                                                                          
L397300300QELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                                                                                                                                                                                                                                               
L397300400QFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L397400100PSEO, ADDITION TO MOBILE ARM SUPPORT, SUPINATOR                                  Mobile arm support supinator32      A                                                                                                     C                          D1D APR     1986010119980101        N                           
L397500100PSHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, SEWHFO cap design w/o jnt CF38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L397500200QMAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                          
L397500300QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L397600100PSHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE      SEWHFO airplane w/o jnts CF 38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L397600200QDESIGN), THORACIC COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INCLUDE SOFT                                                                                                                                                                                                                                        
L397600300QINTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                
L397700100PSHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE OR SEWHFO cap desgn w/jnt(s) CF38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L397700200QMORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE,                                                                                                                                                                                                                                      
L397700300QSTRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L397800100PSHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE      SEWHFO airplane w/jnt(s) CF 38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L397800200QDESIGN), THORACIC COMPONENT AND SUPPORT BAR, INCLUDES ONE OR MORE NONTORSION                                                                                                                                                                                                                                         
L397800300QJOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                                                                                                                                                                                                                                       
L397800400QFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L398000100PUPPER EXTREMITY FRACTURE ORTHOSIS, HUMERAL, PREFABRICATED, INCLUDES FITTING AND Upp ext fx orthosis humeral 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L398000200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L398200100PUPPER EXTREMITY FRACTURE ORTHOSIS, RADIUS/ULNAR, PREFABRICATED, INCLUDES        Upper ext fx orthosis rad/ul38      A                                                                                                     C                          D1F P       1984010120010101        N                           
L398200200QFITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L398400100PUPPER EXTREMITY FRACTURE ORTHOSIS, WRIST, PREFABRICATED, INCLUDES FITTING AND   Upper ext fx orthosis wrist 38      A                                                                                                     C                          D1F P       1982010120010101        N                           
L398400200QADJUSTMENT                                                                                                                                                                                                                                                                                                           
L398500100PUPPER EXTREMITY FRACTURE ORTHOSIS, FOREARM, HAND WITH WRIST HINGE,              Forearm hand fx orth w/ wr h38      A                                                                                                     C                          D1F P       1988010120010101        N                           
L398500200QCUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L398600100PUPPER EXTREMITY FRACTURE ORTHOSIS, COMBINATION OF HUMERAL, RADIUS/ULNAR, WRIST, Humeral rad/ulna wrist fx or38      A                                                                                                     C                          D1F P       1984010120010101        N                           
L398600200Q(EXAMPLE--COLLES' FRACTURE), CUSTOM FABRICATED                                                                                                                                                                                                                                                                       
L399500100PADDITION TO UPPER EXTREMITY ORTHOSIS, SOCK, FRACTURE OR EQUAL, EACH             Sock fracture or equal each 38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L399900100PUPPER LIMB ORTHOSIS, NOT OTHERWISE SPECIFIED                                    Upper limb orthosis NOS     46      A                                                                                                     C                          D1F P       1982010119980101        N                           
L400000100PREPLACE GIRDLE FOR SPINAL ORTHOSIS (CTLSO OR SO)                                Repl girdle milwaukee orth  38      A                                                                                                     C                          D1F P       1985010120020101        N                           
L400200100PREPLACEMENT STRAP, ANY ORTHOSIS, INCLUDES ALL COMPONENTS, ANY LENGTH, ANY TYPE  Replace strap, any orthosis 38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L401000100PREPLACE TRILATERAL SOCKET BRIM                                                  Replace trilateral socket br38      A                                                                                                     C                          D1F P       1985010119960101        N                           
L402000100PREPLACE QUADRILATERAL SOCKET BRIM, MOLDED TO PATIENT MODEL                      Replace quadlat socket brim 38      A                                                                                                     C                          D1F P       1985010119960101        N                           
L403000100PREPLACE QUADRILATERAL SOCKET BRIM, CUSTOM FITTED                                Replace socket brim cust fit38      A                                                                                                     C                          D1F P       1985010119960101        N                           
L404000100PREPLACE MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY                 Replace molded thigh lacer  38      A                                                                                                     C                          D1F P       1985010120050101        N                           
L404500100PREPLACE NON-MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY             Replace non-molded thigh lac38      A                                                                                                     C                          D1F P       1988010120050101        N                           
L405000100PREPLACE MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY                  Replace molded calf lacer   38      A                                                                                                     C                          D1F P       1985010120050101        N                           
L405500100PREPLACE NON-MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY              Replace non-molded calf lace38      A                                                                                                     C                          D1F P       1988010120050101        N                           
L406000100PREPLACE HIGH ROLL CUFF                                                          Replace high roll cuff      38      A                                                                                                     C                          D1F P       1985010119960101        N                           
L407000100PREPLACE PROXIMAL AND DISTAL UPRIGHT FOR KAFO                                    Replace prox & dist upright 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L408000100PREPLACE METAL BANDS KAFO, PROXIMAL THIGH                                        Repl met band kafo-afo prox 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L409000100PREPLACE METAL BANDS KAFO-AFO, CALF OR DISTAL THIGH                              Repl met band kafo-afo calf/38      A                                                                                                     C                          D1F P       1985010119960101        N                           
L410000100PREPLACE LEATHER CUFF KAFO, PROXIMAL THIGH                                       Repl leath cuff kafo prox th38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L411000100PREPLACE LEATHER CUFF KAFO-AFO, CALF OR DISTAL THIGH                             Repl leath cuff kafo-afo cal38      A                                                                                                     C                          D1F P       1985010119960101        N                           
L413000100PREPLACE PRETIBIAL SHELL                                                         Replace pretibial shell     38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L420500100PREPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES                      Ortho dvc repair per 15 min 46      A                  2100.4                                                                             D                          D1F P       1997010119970101        N                           
L421000100PREPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS                        Orth dev repair/repl minor p46      A                  2133    2100.4  2130D                                                              D                          D1F P       1985010119960101        N                           
L435000100PANKLE CONTROL ORTHOSIS, STIRRUP STYLE, RIGID, INCLUDES ANY TYPE INTERFACE       Ankle control orthosi prefab38      A                                                                                                     C                          D1F P       1989010120040101        N                           
L435000200Q(E.G., PNEUMATIC, GEL),  PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                              
L436000100PWALKING BOOT, PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE      Pneumati walking boot prefab38      A                                                                                                     C                          D1F P       1989010120040101        N                           
L436000200QMATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                             
L437000100PPNEUMATIC FULL LEG SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT       Pneumatic full leg splint   38      A                                                                                                     C                          D1F P       1989010120030101        N                           
L438000100PPNEUMATIC KNEE SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT           Pneumatic knee splint       38      A                                                                                                     C                          D1F P       1989010120030101        N                           
L438600100PWALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE  Non-pneum walk boot prefab  38      A                                                                                                     C                          D1F P       2003010120040101        N                           
L438600200QMATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                             
L439200100PREPLACEMENT, SOFT INTERFACE MATERIAL, STATIC AFO                                Replace AFO soft interface  38      A                                                                                                     C                          D1F P       1997010120010101        N                           
L439400100PREPLACE SOFT INTERFACE MATERIAL, FOOT DROP SPLINT                               Replace foot drop spint     38      A                                                                                                     C                          D1F P       1997010119970101        N                           
L439600100PSTATIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL,  ADJUSTABLE FOR  Static AFO                  38      A                                                                                                     C                          D1F P       1997010120020101        N                           
L439600200QFIT, FOR  POSITIONING, PRESSURE REDUCTION, MAY BE USED FOR MINIMAL AMBULATION,                                                                                                                                                                                                                                       
L439600300QPREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L439800100PFOOT DROP SPLINT, RECUMBENT POSITIONING DEVICE, PREFABRICATED, INCLUDES FITTING Foot drop splint recumbent  38      A                                                                                                     C                          D1F P       1997010120010101        N                           
L439800200QAND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L500000100PPARTIAL FOOT, SHOE INSERT WITH LONGITUDINAL ARCH, TOE FILLER                    Sho insert w arch toe filler38      A                  2323                                                                               D                          D1F P       1982010119960101        N                           
L501000100PPARTIAL FOOT, MOLDED SOCKET, ANKLE HEIGHT, WITH TOE FILLER                      Mold socket ank hgt w/ toe f38      A                  2323                                                                               D                          D1F P       1982010119960101        N                           
L502000100PPARTIAL FOOT, MOLDED SOCKET, TIBIAL TUBERCLE HEIGHT, WITH TOE FILLER            Tibial tubercle hgt w/ toe f38      A                  2323                                                                               D                          D1F P       1982010119960101        N                           
L505000100PANKLE, SYMES, MOLDED SOCKET, SACH FOOT                                          Ank symes mold sckt sach ft 38      A                                                                                                     C                          D1F P       1985010119960101        N                           
L506000100PANKLE, SYMES, METAL FRAME, MOLDED LEATHER SOCKET, ARTICULATED ANKLE/FOOT        Symes met fr leath socket ar38      A                                                                                                     C                          D1F P       1985010119960101        N                           
L510000100PBELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT                                      Molded socket shin sach foot38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L510500100PBELOW KNEE, PLASTIC SOCKET, JOINTS AND THIGH LACER, SACH FOOT                   Plast socket jts/thgh lacer 38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L515000100PKNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS,    Mold sckt ext knee shin sach38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L515000200QSHIN, SACH FOOT                                                                                                                                                                                                                                                                                                      
L516000100PKNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, BENT KNEE CONFIGURATION, Mold socket bent knee shin s38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L516000200QEXTERNAL KNEE JOINTS, SHIN, SACH FOOT                                                                                                                                                                                                                                                                                
L520000100PABOVE KNEE, MOLDED SOCKET, SINGLE AXIS CONSTANT FRICTION KNEE, SHIN, SACH FOOT  Kne sing axis fric shin sach38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L521000100PABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH FOOT BLOCKS, NO  No knee/ankle joints w/ ft b38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L521000200QANKLE JOINTS, EACH                                                                                                                                                                                                                                                                                                   
L522000100PABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH ARTICULATED      No knee joint with artic ali38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L522000200QANKLE/FOOT, DYNAMICALLY ALIGNED, EACH                                                                                                                                                                                                                                                                                
L523000100PABOVE KNEE, FOR PROXIMAL FEMORAL FOCAL DEFICIENCY, CONSTANT FRICTION KNEE,      Fem focal defic constant fri38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L523000200QSHIN, SACH FOOT                                                                                                                                                                                                                                                                                                      
L525000100PHIP DISARTICULATION, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS       Hip canad sing axi cons fric38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L525000200QCONSTANT FRICTION KNEE, SHIN, SACH FOOT                                                                                                                                                                                                                                                                              
L527000100PHIP DISARTICULATION, TILT TABLE TYPE; MOLDED SOCKET, LOCKING HIP JOINT, SINGLE  Tilt table locking hip sing 38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L527000200QAXIS CONSTANT FRICTION KNEE, SHIN, SACH FOOT                                                                                                                                                                                                                                                                         
L528000100PHEMIPELVECTOMY, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS CONSTANT   Hemipelvect canad sing axis 38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L528000200QFRICTION KNEE, SHIN, SACH FOOT                                                                                                                                                                                                                                                                                       
L530100100PBELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT, ENDOSKELETAL SYSTEM                 BK mold socket SACH ft endo 38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L531100100PKNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS,    Knee disart, SACH ft, endo  38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L531100200QSHIN, SACH FOOT, ENDOSKELETAL SYSTEM                                                                                                                                                                                                                                                                                 
L532100100PABOVE KNEE, MOLDED SOCKET, OPEN END, SACH FOOT, ENDOSKELETAL SYSTEM, SINGLE     AK open end SACH            38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L532100200QAXIS KNEE                                                                                                                                                                                                                                                                                                            
L533100100PHIP DISARTICULATION, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP     Hip disart canadian SACH ft 38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L533100200QJOINT, SINGLE AXIS KNEE, SACH FOOT                                                                                                                                                                                                                                                                                   
L534100100PHEMIPELVECTOMY, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP JOINT,   Hemipelvectomy canadian SACH38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L534100200QSINGLE AXIS KNEE, SACH FOOT                                                                                                                                                                                                                                                                                          
L540000100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dress & 1 cast chg bk38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L540000200QDRESSING, INCLUDING FITTING, ALIGNMENT, SUSPENSION, AND ONE CAST CHANGE, BELOW                                                                                                                                                                                                                                       
L540000300QKNEE                                                                                                                                                                                                                                                                                                                 
L541000100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dsg bk ea add cast ch38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L541000200QDRESSING, INCLUDING FITTING, ALIGNMENT AND SUSPENSION, BELOW KNEE, EACH                                                                                                                                                                                                                                              
L541000300QADDITIONAL CAST CHANGE AND REALIGNMENT                                                                                                                                                                                                                                                                               
L542000100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dsg & 1 cast chg ak/d38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L542000200QDRESSING, INCLUDING FITTING, ALIGNMENT AND SUSPENSION AND ONE CAST CHANGE 'AK'                                                                                                                                                                                                                                       
L542000300QOR KNEE DISARTICULATION                                                                                                                                                                                                                                                                                              
L543000100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dsg ak ea add cast ch38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L543000200QDRESSING, INCL. FITTING, ALIGNMENT AND SUPENSION, 'AK' OR KNEE DISARTICULATION,                                                                                                                                                                                                                                      
L543000300QEACH ADDITIONAL CAST CHANGE AND REALIGNMENT                                                                                                                                                                                                                                                                          
L545000100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING     Postop app non-wgt bear dsg 38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L545000200QRIGID DRESSING, BELOW KNEE                                                                                                                                                                                                                                                                                           
L546000100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING     Postop app non-wgt bear dsg 38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L546000200QRIGID DRESSING, ABOVE KNEE                                                                                                                                                                                                                                                                                           
L550000100PINITIAL, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER,   Init bk ptb plaster direct  38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L550000200QSACH FOOT, PLASTER SOCKET, DIRECT FORMED                                                                                                                                                                                                                                                                             
L550500100PINITIAL, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE Init ak ischal plstr direct 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L550500200QSYSTEM, PYLON, NO COVER, SACH FOOT, PLASTER SOCKET, DIRECT FORMED                                                                                                                                                                                                                                                    
L551000100PPREPARATORY, BELOW KNEE  'PTB'  TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO    Prep BK ptb plaster molded  38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L551000200QCOVER, SACH FOOT, PLASTER SOCKET, MOLDED TO MODEL                                                                                                                                                                                                                                                                    
L552000100PPREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO      Perp BK ptb thermopls direct38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L552000200QCOVER, SACH FOOT, THERMOPLASTIC OR EQUAL, DIRECT FORMED                                                                                                                                                                                                                                                              
L553000100PPREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO      Prep BK ptb thermopls molded38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L553000200QCOVER, SACH FOOT, THERMOPLASTIC OR EQUAL, MOLDED TO MODEL                                                                                                                                                                                                                                                            
L553500100PPREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, NO COVER, SACH Prep BK ptb open end socket 38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L553500200QFOOT, PREFABRICATED, ADJUSTABLE OPEN END SOCKET                                                                                                                                                                                                                                                                      
L554000100PPREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO      Prep BK ptb laminated socket38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L554000200QCOVER, SACH FOOT, LAMINATED SOCKET, MOLDED TO MODEL                                                                                                                                                                                                                                                                  
L556000100PPREPARATORY, ABOVE KNEE- KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET,            Prep AK ischial plast molded38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L556000200QNON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, PLASTER SOCKET, MOLDED TO                                                                                                                                                                                                                                          
L556000300QMODEL                                                                                                                                                                                                                                                                                                                
L557000100PPREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET,           Prep AK ischial direct form 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L557000200QNON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, THERMOPLASTIC OR EQUAL,                                                                                                                                                                                                                                            
L557000300QDIRECT FORMED                                                                                                                                                                                                                                                                                                        
L558000100PPREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET,            Prep AK ischial thermo mold 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L558000200QNON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, THERMOPLASTIC OR EQUAL,                                                                                                                                                                                                                                            
L558000300QMOLDED TO MODEL                                                                                                                                                                                                                                                                                                      
L558500100PPREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET,           Prep AK ischial open end    38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L558500200QNON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, PREFABRICATED ADJUSTABLE OPEN                                                                                                                                                                                                                                      
L558500300QEND SOCKET                                                                                                                                                                                                                                                                                                           
L559000100PPREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET,            Prep AK ischial laminated   38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L559000200QNON-ALIGNABLE SYSTEM, PYLON NO COVER, SACH FOOT,  LAMINATED SOCKET, MOLDED TO                                                                                                                                                                                                                                        
L559000300QMODEL                                                                                                                                                                                                                                                                                                                
L559500100PPREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT,    Hip disartic sach thermopls 38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L559500200QTHERMOPLASTIC OR EQUAL, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                      
L560000100PPREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT,    Hip disart sach laminat mold38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L560000200QLAMINATED SOCKET, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                            
L561000100PADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, HYDRACADENCE      Above knee hydracadence     38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L561000200QSYSTEM                                                                                                                                                                                                                                                                                                               
L561100100PADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE - KNEE             Ak 4 bar link w/fric swing  38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L561100200QDISARTICULATION, 4 BAR LINKAGE, WITH FRICTION SWING PHASE CONTROL                                                                                                                                                                                                                                                    
L561300100PADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE-KNEE               Ak 4 bar ling w/hydraul swig38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L561300200QDISARTICULATION, 4 BAR LINKAGE, WITH HYDRAULIC SWING PHASE CONTROL                                                                                                                                                                                                                                                   
L561400100PADDITION TO LOWER EXTREMITY, EXOSKELETAL SYSTEM, ABOVE KNEE-KNEE                4-bar link above knee w/swng38      A                                                                                                     C                          D1F P       1994010119960101        N                           
L561400200QDISARTICULATION, 4 BAR LINKAGE, WITH PNEUMATIC SWING PHASE CONTROL                                                                                                                                                                                                                                                   
L561600100PADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, UNIVERSAL         Ak univ multiplex sys frict 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L561600200QMULTIPLEX SYSTEM, FRICTION SWING PHASE CONTROL                                                                                                                                                                                                                                                                       
L561700100PADDITION TO LOWER EXTREMITY, QUICK CHANGE SELF-ALIGNING UNIT, ABOVE KNEE OR     AK/BK self-aligning unit ea 38      A                                                                                                     C                          D1F P       1996010119960101        N                           
L561700200QBELOW KNEE, EACH                                                                                                                                                                                                                                                                                                     
L561800100PADDITION TO LOWER EXTREMITY, TEST SOCKET, SYMES                                 Test socket symes           38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L562000100PADDITION TO LOWER EXTREMITY, TEST SOCKET, BELOW KNEE                            Test socket below knee      38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L562200100PADDITION TO LOWER EXTREMITY, TEST SOCKET, KNEE DISARTICULATION                  Test socket knee disarticula38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L562400100PADDITION TO LOWER EXTREMITY, TEST SOCKET, ABOVE KNEE                            Test socket above knee      38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L562600100PADDITION TO LOWER EXTREMITY, TEST SOCKET, HIP DISARTICULATION                   Test socket hip disarticulat38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L562800100PADDITION TO LOWER EXTREMITY, TEST SOCKET, HEMIPELVECTOMY                        Test socket hemipelvectomy  38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L562900100PADDITION TO LOWER EXTREMITY, BELOW KNEE, ACRYLIC SOCKET                         Below knee acrylic socket   38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L563000100PADDITION TO LOWER EXTREMITY, SYMES TYPE, EXPANDABLE WALL SOCKET                 Syme typ expandabl wall sckt38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L563100100PADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, ACRYLIC SOCKET Ak/knee disartic acrylic soc38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L563200100PADDITION TO LOWER EXTREMITY, SYMES TYPE,  'PTB' BRIM DESIGN SOCKET              Symes type ptb brim design s38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L563400100PADDITION TO LOWER EXTREMITY, SYMES TYPE, POSTERIOR OPENING (CANADIAN) SOCKET    Symes type poster opening so38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L563600100PADDITION  TO LOWER EXTREMITY, SYMES TYPE, MEDIAL OPENING SOCKET                 Symes type medial opening so38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L563700100PADDITION TO LOWER EXTREMITY, BELOW KNEE, TOTAL CONTACT                          Below knee total contact    38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L563800100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, LEATHER SOCKET                        Below knee leather socket   38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L563900100PADDITION TO LOWER EXTREMITY, BELOW KNEE, WOOD SOCKET                            Below knee wood socket      38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L564000100PADDITION  TO LOWER EXTREMITY, KNEE DISARTICULATION, LEATHER SOCKET              Knee disarticulat leather so38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L564200100PADDITION  TO LOWER EXTREMITY, ABOVE KNEE, LEATHER SOCKET                        Above knee leather socket   38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L564300100PADDITION  TO LOWER EXTREMITY, HIP DISARTICULATION, FLEXIBLE INNER SOCKET,       Hip flex inner socket ext fr38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L564300200QEXTERNAL FRAME                                                                                                                                                                                                                                                                                                       
L564400100PADDITION  TO LOWER EXTREMITY, ABOVE KNEE, WOOD SOCKET                           Above knee wood socket      38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L564500100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME Bk flex inner socket ext fra38      A                                                                                                     C                          D1F P       1988010120001213        N                           
L564600100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, AIR, FLUID, GEL OR EQUAL, CUSHION     Below knee cushion socket   38      A                                                                                                     C                          D1F P       1986010120040101        N                           
L564600200QSOCKET                                                                                                                                                                                                                                                                                                               
L564700100PADDITION  TO LOWER EXTREMITY, BELOW KNEE SUCTION SOCKET                         Below knee suction socket   38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L564800100PADDITION  TO LOWER EXTREMITY, ABOVE KNEE, AIR, FLUID, GEL OR EQUAL,  CUSHION    Above knee cushion socket   38      A                                                                                                     C                          D1F P       1986010120040101        N                           
L564800200QSOCKET                                                                                                                                                                                                                                                                                                               
L564900100PADDITION  TO LOWER EXTREMITY, ISCHIAL CONTAINMENT/NARROW M-L SOCKET             Isch containmt/narrow m-l so38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L565000100PADDITIONS TO LOWER EXTREMITY, TOTAL CONTACT, ABOVE KNEE OR KNEE DISARTICULATION Tot contact ak/knee disart s38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L565000200QSOCKET                                                                                                                                                                                                                                                                                                               
L565100100PADDITION  TO LOWER EXTREMITY, ABOVE KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME Ak flex inner socket ext fra38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L565200100PADDITION  TO LOWER EXTREMITY, SUCTION SUSPENSION, ABOVE KNEE OR KNEE            Suction susp ak/knee disart 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L565200200QDISARTICULATION SOCKET                                                                                                                                                                                                                                                                                               
L565300100PADDITION  TO LOWER EXTREMITY, KNEE DISARTICULATION, EXPANDABLE WALL SOCKET      Knee disart expand wall sock38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L565400100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, SYMES, (KEMBLO, PELITE, ALIPLAST,  Socket insert symes         38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L565400200QPLASTAZOTE OR EQUAL)                                                                                                                                                                                                                                                                                                 
L565500100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, BELOW KNEE (KEMBLO, PELITE,        Socket insert below knee    38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L565500200QALIPLAST, PLASTAZOTE OR EQUAL)                                                                                                                                                                                                                                                                                       
L565600100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, KNEE DISARTICULATION (KEMBLO,      Socket insert knee articulat38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L565600200QPELITE, ALIPLAST, PLASTAZOTE OR EQUAL)                                                                                                                                                                                                                                                                               
L565800100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, ABOVE KNEE (KEMBLO, PELITE,        Socket insert above knee    38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L565800200QALIPLAST, PLASTAZOTE OR EQUAL)                                                                                                                                                                                                                                                                                       
L566000100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, SYMES, SILICONE GEL OR EQUAL       Sock insrt syme silicone gel00      9                                                                                                     G                          D1F P       198601012003010120021231N                           
L566100100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER SYMES              Multi-durometer symes       38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L566200100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, BELOW KNEE, SILICONE GEL OR EQUAL  Socket insert bk silicone ge00      9                                                                                                     G                          D1F P       198601012003010120021231N                           
L566300100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, KNEE DISARTICULATION, SILICONE GEL Sock knee disartic silicone 00      9                                                                                                     G                          D1F P       198601012003010120021231N                           
L566300200QOR EQUAL                                                                                                                                                                                                                                                                                                             
L566400100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, ABOVE KNEE, SILICONE GEL OR EQUAL  Socket insert ak silicone ge00      9                                                                                                     G                          D1F P       198601012003010120021231N                           
L566500100PADDITION  TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER, BELOW KNEE        Multi-durometer below knee  38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L566600100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, CUFF SUSPENSION                       Below knee cuff suspension  38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L566800100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, MOLDED DISTAL CUSHION                 Socket insert w/o lock lower38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L567000100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, MOLDED SUPRACONDYLAR SUSPENSION       Bk molded supracondylar susp38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L567000200Q('PTS' OR SIMILAR)                                                                                                                                                                                                                                                                                                   
L567100100PADDITION TO LOWER EXTREMITY, BELOW KNEE / ABOVE KNEE SUSPENSION LOCKING         BK/AK locking mechanism     38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L567100200QMECHANISM (SHUTTLE, LANYARD OR EQUAL), EXCLUDES SOCKET INSERT                                                                                                                                                                                                                                                        
L567200100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, REMOVABLE MEDIAL BRIM SUSPENSION      Bk removable medial brim sus38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L567300100PADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM      Socket insert w lock mech   38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L567300200QEXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR                                                                                                                                                                                                                                          
L567300300QEQUAL, FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                                
L567400100PADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, ANY MATERIAL,  EACH Bk suspension sleeve        38      A                                                                            L5685                    C                          D1F P       198601012005010120041231N                           
L567500100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, HEAVY DUTY, ANY    Bk heavy duty susp sleeve   38      A                                                                            L5685                    C                          D1F P       198801012005010120041231N                           
L567500200QMATERIAL, EACH                                                                                                                                                                                                                                                                                                       
L567600100PADDITIONS TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, SINGLE AXIS, PAIR        Bk knee joints single axis p38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L567700100PADDITIONS TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, POLYCENTRIC, PAIR        Bk knee joints polycentric p38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L567800100PADDITIONS TO LOWER EXTREMITY, BELOW KNEE, JOINT COVERS, PAIR                    Bk joint covers pair        38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L567900100PADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM      Socket insert w/o lock mech 38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L567900200QEXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR                                                                                                                                                                                                                                          
L567900300QEQUAL, NOT FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                            
L568000100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, NONMOLDED                Bk thigh lacer non-molded   38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L568100100PADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET    Intl custm cong/latyp insert38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L568100200QINSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC                                                                                                                                                                                                                                       
L568100300QOR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER                                                                                                                                                                                                                                         
L568100400QTHAN INITIAL, USE CODE L5673 OR L5679)                                                                                                                                                                                                                                                                               
L568200100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, GLUTEAL/ISCHIAL, MOLDED  Bk thigh lacer glut/ischia m38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L568300100PADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET    Initial custom socket insert38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L568300200QINSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL,                                                                                                                                                                                                                                        
L568300300QELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY                                                                                                                                                                                                                                        
L568300400Q(FOR OTHER THAN INITIAL, USE CODE L5673 OR L5679)                                                                                                                                                                                                                                                                    
L568400100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, FORK STRAP                            Bk fork strap               38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L568500100PADDITION TO LOWER EXTREMITY PROSTHESIS, BELOW KNEE, SUSPENSION/SEALING SLEEVE,  Below knee sus/seal sleeve  38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L568500200QWITH OR WITHOUT VALVE, ANY MATERIAL, EACH                                                                                                                                                                                                                                                                            
L568600100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, BACK CHECK (EXTENSION CONTROL)        Bk back check               38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L568800100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, WAIST BELT, WEBBING                   Bk waist belt webbing       38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L569000100PADDITION  TO LOWER EXTREMITY, BELOW KNEE, WAIST BELT, PADDED AND LINED          Bk waist belt padded and lin38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L569200100PADDITION  TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, LIGHT            Ak pelvic control belt light38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L569400100PADDITION  TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, PADDED AND LINED Ak pelvic control belt pad/l38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L569500100PADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL, SLEEVE SUSPENSION,     Ak sleeve susp neoprene/equa38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L569500200QNEOPRENE OR EQUAL, EACH                                                                                                                                                                                                                                                                                              
L569600100PADDITION  TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC JOINT  Ak/knee disartic pelvic join38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L569700100PADDITION  TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC BAND   Ak/knee disartic pelvic band38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L569800100PADDITION  TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, SILESIAN      Ak/knee disartic silesian ba38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L569800200QBANDAGE                                                                                                                                                                                                                                                                                                              
L569900100PALL LOWER EXTREMITY PROSTHESES, SHOULDER HARNESS                                Shoulder harness            38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L570000100PREPLACEMENT, SOCKET, BELOW KNEE, MOLDED TO PATIENT MODEL                        Replace socket below knee   38      A                                                                                                     C                          D1F P       1994010119940101        N                           
L570100100PREPLACEMENT, SOCKET, ABOVE KNEE/KNEE DISARTICULATION, INCLUDING ATTACHMENT      Replace socket above knee   38      A                                                                                                     C                          D1F P       1994010119940101        N                           
L570100200QPLATE, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                       
L570200100PREPLACEMENT, SOCKET, HIP DISARTICULATION, INCLUDING HIP JOINT, MOLDED TO        Replace socket hip          38      A                                                                                                     C                          D1F P       1994010119940101        N                           
L570200200QPATIENT MODEL                                                                                                                                                                                                                                                                                                        
L570300100PANKLE, SYMES, MOLDED TO PATIENT MODEL, SOCKET WITHOUT SOLID ANKLE CUSHION HEEL  Symes ankle w/o (SACH) foot 38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L570300200Q(SACH) FOOT, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                        
L570400100PCUSTOM SHAPED PROTECTIVE COVER, BELOW KNEE                                      Custom shape cover BK       38      A                                                                                                     C                          D1F P       1994010120020101        N                           
L570500100PCUSTOM SHAPED PROTECTIVE COVER, ABOVE KNEE                                      Custom shape cover AK       38      A                                                                                                     C                          D1F P       1994010120020101        N                           
L570600100PCUSTOM SHAPED PROTECTIVE COVER, KNEE DISARTICULATION                            Custom shape cvr knee disart38      A                                                                                                     C                          D1F P       1994010120020101        N                           
L570700100PCUSTOM SHAPED PROTECTIVE COVER, HIP DISARTICULATION                             Custom shape cvr hip disart 38      A                                                                                                     C                          D1F P       1994010120020101        N                           
L571000100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK               Kne-shin exo sng axi mnl loc38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L571100100PADDITIONS EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT   Knee-shin exo mnl lock ultra38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L571100200QMATERIAL                                                                                                                                                                                                                                                                                                             
L571200100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE Knee-shin exo frict swg & st38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L571200200QPHASE CONTROL (SAFETY KNEE)                                                                                                                                                                                                                                                                                          
L571400100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, VARIABLE FRICTION SWING   Knee-shin exo variable frict38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L571400200QPHASE CONTROL                                                                                                                                                                                                                                                                                                        
L571600100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE   Knee-shin exo mech stance ph38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L571600200QLOCK                                                                                                                                                                                                                                                                                                                 
L571800100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC,  FRICTION SWING AND       Knee-shin exo frct swg & sta38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L571800200QSTANCE PHASE CONTROL                                                                                                                                                                                                                                                                                                 
L572200100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION Knee-shin pneum swg frct exo38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L572200200QSTANCE PHASE CONTROL                                                                                                                                                                                                                                                                                                 
L572400100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL Knee-shin exo fluid swing ph38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L572600100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, EXTERNAL JOINTS FLUID     Knee-shin ext jnts fld swg e38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L572600200QSWING PHASE CONTROL                                                                                                                                                                                                                                                                                                  
L572800100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE    Knee-shin fluid swg & stance38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L572800200QPHASE CONTROL                                                                                                                                                                                                                                                                                                        
L578000100PADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/HYDRA PNEUMATIC Knee-shin pneum/hydra pneum 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L578000200QSWING PHASE CONTROL                                                                                                                                                                                                                                                                                                  
L578100100PADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT Lower limb pros vacuum pump 38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L578100200QAND MOISTURE EVACUATION SYSTEM                                                                                                                                                                                                                                                                                       
L578200100PADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT HD low limb pros vacuum pump38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L578200200QAND MOISTURE EVACUATION SYSTEM, HEAVY DUTY                                                                                                                                                                                                                                                                           
L578500100PADDITION, EXOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,       Exoskeletal bk ultralt mater38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L578500200QCARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                               
L579000100PADDITION, EXOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,       Exoskeletal ak ultra-light m38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L579000200QCARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                               
L579500100PADDITION, EXOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL         Exoskel hip ultra-light mate38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L579500200Q(TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                    
L581000100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK               Endoskel knee-shin mnl lock 38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L581100100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT  Endo knee-shin mnl lck ultra38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L581100200QMATERIAL                                                                                                                                                                                                                                                                                                             
L581200100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE Endo knee-shin frct swg & st38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L581200200QPHASE CONTROL (SAFETY KNEE)                                                                                                                                                                                                                                                                                          
L581400100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, HYDRAULIC SWING PHASE     Endo knee-shin hydral swg ph38      A                                                                                                     C                          D1F P       1997010119970101        N                           
L581400200QCONTROL, MECHANICAL STANCE PHASE LOCK                                                                                                                                                                                                                                                                                
L581600100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE   Endo knee-shin polyc mch sta38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L581600200QLOCK                                                                                                                                                                                                                                                                                                                 
L581800100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING, AND       Endo knee-shin frct swg & st38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L581800200QSTANCE PHASE CONTROL                                                                                                                                                                                                                                                                                                 
L582200100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION Endo knee-shin pneum swg frc38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L582200200QSTANCE PHASE CONTROL                                                                                                                                                                                                                                                                                                 
L582400100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL Endo knee-shin fluid swing p38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L582600100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, HYDRAULIC SWING PHASE     Miniature knee joint        38      A                                                                                                     C                          D1F P       1998010119990101        N                           
L582600200QCONTROL, WITH MINIATURE HIGH ACTIVITY FRAME                                                                                                                                                                                                                                                                          
L582800100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE    Endo knee-shin fluid swg/sta38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L582800200QPHASE CONTROL                                                                                                                                                                                                                                                                                                        
L583000100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/ SWING PHASE    Endo knee-shin pneum/swg pha38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L583000200QCONTROL                                                                                                                                                                                                                                                                                                              
L584000100PADDITION, ENDOSKELETAL KNEE/SHIN SYSTEM, 4-BAR LINKAGE OR MULTIAXIAL, PNEUMATIC Multi-axial knee/shin system38      A                                                                                                     C                          D1F P       1994010119990101        N                           
L584000200QSWING PHASE CONTROL                                                                                                                                                                                                                                                                                                  
L584500100PADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, STANCE FLEXION FEATURE, ADJUSTABLE    Knee-shin sys stance flexion38      A                                                                                                     C                          D1F P       1996010119960101        N                           
L584600100PADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING Knee-shin sys microprocessor38      A                                                                                                     C                          D1F P       199601012005010120041231N                           
L584600200QPHASE ONLY                                                                                                                                                                                                                                                                                                           
L584700100PADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE Microprocessor cntrl feature38      A                                                                                                     C                          D1F P       200201012005010120041231N                           
L584700200QPHASE                                                                                                                                                                                                                                                                                                                
L584800100PADDITION TO ENDOSKELETAL, KNEE-SHIN SYSTEM, HYDRAULIC STANCE EXTENSION,         Knee-shin sys hydraul stance38      A                                                                                                     C                          D1F P       2003010120040101        N                           
L584800200QDAMPENING FEATURE, WITH OR WITHOUT ADJUSTABILITY                                                                                                                                                                                                                                                                     
L585000100PADDITION,  ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, KNEE         Endo ak/hip knee extens assi38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L585000200QEXTENSION ASSIST                                                                                                                                                                                                                                                                                                     
L585500100PADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, MECHANICAL HIP EXTENSION    Mech hip extension assist   38      A                                                                                                     C                          D1F P       1994010119950101        N                           
L585500200QASSIST                                                                                                                                                                                                                                                                                                               
L585600100PADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM,          Elec knee-shin swing/stance 38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L585600200QMICROPROCESSOR CONTROL FEATURE, SWING AND STANCE PHASE, INCLUDES ELECTRONIC                                                                                                                                                                                                                                          
L585600300QSENSOR(S), ANY TYPE                                                                                                                                                                                                                                                                                                  
L585700100PADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM,          Elec knee-shin swing only   38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L585700200QMICROPROCESSOR CONTROL FEATURE, SWING PHASE ONLY, INCLUDES ELECTRONIC                                                                                                                                                                                                                                                
L585700300QSENSOR(S), ANY TYPE                                                                                                                                                                                                                                                                                                  
L585800100PADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM,          Stance phase only           38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L585800200QMICROPROCESSOR CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC                                                                                                                                                                                                                                               
L585800300QSENSOR(S), ANY TYPE                                                                                                                                                                                                                                                                                                  
L591000100PADDITION,  ENDOSKELETAL SYSTEM, BELOW KNEE, ALIGNABLE SYSTEM                    Endo below knee alignable sy38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L592000100PADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, ALIGNABLE     Endo ak/hip alignable system38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L592000200QSYSTEM                                                                                                                                                                                                                                                                                                               
L592500100PADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, KNEE DISARTICULATION OR HIP          Above knee manual lock      38      A                                                                                                     C                          D1F P       1994010120000101        N                           
L592500200QDISARTICULATION, MANUAL LOCK                                                                                                                                                                                                                                                                                         
L593000100PADDITION, ENDOSKELETAL SYSTEM, HIGH ACTIVITY KNEE CONTROL FRAME                 High activity knee frame    38      A                                                                                                     C                          D1F P       1996010119960101        N                           
L594000100PADDITION,  ENDOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,     Endo bk ultra-light material38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L594000200QCARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                               
L595000100PADDITION,  ENDOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,     Endo ak ultra-light material38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L595000200QCARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                               
L596000100PADDITION,  ENDOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL       Endo hip ultra-light materia38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L596000200Q(TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                    
L596200100PADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE    Below knee flex cover system38      A                                                                                                     C                          D1F P       1994010119940101        N                           
L596200200QCOVERING SYSTEM                                                                                                                                                                                                                                                                                                      
L596400100PADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE    Above knee flex cover system38      A                                                                                                     C                          D1F P       1994010119940101        N                           
L596400200QCOVERING SYSTEM                                                                                                                                                                                                                                                                                                      
L596600100PADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, FLEXIBLE PROTECTIVE OUTER   Hip flexible cover system   38      A                                                                                                     C                          D1F P       1994010119940101        N                           
L596600200QSURFACE COVERING SYSTEM                                                                                                                                                                                                                                                                                              
L596800100PADDITION TO LOWER LIMB PROSTHESIS, MULTIAXIAL ANKLE WITH SWING PHASE ACTIVE     Multiaxial ankle w dorsiflex38      A                                                                                                     C                          D1F P       1999010120000101        N                           
L596800200QDORSIFLEXION FEATURE                                                                                                                                                                                                                                                                                                 
L597000100PALL LOWER EXTREMITY PROSTHESES, FOOT, EXTERNAL KEEL, SACH FOOT                  Foot external keel sach foot38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L597100100PALL LOWER EXTREMITY PROSTHESIS, SOLID ANKLE CUSHION HEEL (SACH) FOOT,           SACH foot, replacement      38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L597100200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
L597200100PALL LOWER EXTREMITY PROSTHESES, FLEXIBLE KEEL FOOT (SAFE, STEN, BOCK DYNAMIC OR Flexible keel foot          38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L597200200QEQUAL)                                                                                                                                                                                                                                                                                                               
L597400100PALL LOWER EXTREMITY PROSTHESES, FOOT, SINGLE AXIS ANKLE/FOOT                    Foot single axis ankle/foot 38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L597500100PALL LOWER EXTREMITY PROSTHESIS, COMBINATION SINGLE AXIS ANKLE AND FLEXIBLE KEEL Combo ankle/foot prosthesis 38      A                                                                                                     C                          D1F P       1999010119990101        N                           
L597500200QFOOT                                                                                                                                                                                                                                                                                                                 
L597600100PALL LOWER EXTREMITY PROSTHESES, ENERGY STORING FOOT (SEATTLE CARBON COPY II OR  Energy storing foot         38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L597600200QEQUAL)                                                                                                                                                                                                                                                                                                               
L597800100PALL LOWER EXTREMITY PROSTHESES, FOOT, MULTIAXIAL ANKLE/FOOT                     Ft prosth multiaxial ankl/ft38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L597900100PALL LOWER EXTREMITY PROSTHESIS, MULTI-AXIAL ANKLE, DYNAMIC RESPONSE FOOT, ONE   Multi-axial ankle/ft prosth 38      A                                                                                                     C                          D1F P       1994010120010101        N                           
L597900200QPIECE SYSTEM                                                                                                                                                                                                                                                                                                         
L598000100PALL LOWER EXTREMITY PROSTHESES, FLEX FOOT SYSTEM                                Flex foot system            38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L598100100PALL LOWER EXTREMITY PROSTHESES, FLEX-WALK SYSTEM OR EQUAL                       Flex-walk sys low ext prosth38      A                                                                                                     C                          D1F P       1994010119940101        N                           
L598200100PALL EXOSKELETAL LOWER EXTREMITY PROSTHESES, AXIAL ROTATION UNIT                 Exoskeletal axial rotation u38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L598400100PALL ENDOSKELETAL LOWER EXTREMITY PROSTHESIS, AXIAL ROTATION UNIT, WITH OR       Endoskeletal axial rotation 38      A                                                                                                     C                          D1F P       1989010120040101        N                           
L598400200QWITHOUT ADJUSTABILITY                                                                                                                                                                                                                                                                                                
L598500100PALL ENDOSKELETAL LOWER EXTREMITY PROSTHESES, DYNAMIC PROSTHETIC PYLON           Lwr ext dynamic prosth pylon38      A                                                                                                     C                          D1F P       1996010119960101        N                           
L598600100PALL LOWER EXTREMITY PROSTHESES, MULTI-AXIAL ROTATION UNIT ('MCP' OR EQUAL)      Multi-axial rotation unit   38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L598700100PALL LOWER EXTREMITY PROSTHESIS, SHANK FOOT SYSTEM WITH VERTICAL LOADING PYLON   Shank ft w vert load pylon  38      A                                                                                                     C                          D1F P       1997010119970101        N                           
L598800100PADDITION TO LOWER LIMB PROSTHESIS, VERTICAL SHOCK REDUCING PYLON FEATURE        Vertical shock reducing pylo38      A                                                                                                     C                          D1F P       1999010120000101        N                           
L598900100PADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL SYSTEM, PYLON WITH         Pylon w elctrnc force sensor38      A                                                                                                     C                          D1F P       200201012005010120041231N                           
L598900200QINTEGRATED ELECTRONIC FORCE SENSORS                                                                                                                                                                                                                                                                                  
L599000100PADDITION TO LOWER EXTREMITY PROSTHESIS, USER ADJUSTABLE HEEL HEIGHT             User adjustable heel height 38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L599500100PADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE (FOR PATIENT WEIGHT  Lower ext pros heavyduty fea38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L599500200Q> 300 LBS)                                                                                                                                                                                                                                                                                                           
L599900100PLOWER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED                             Lowr extremity prosthes NOS 46      A                                                                                                     C                          D1F P       1982010119980101        N                           
L600000100PPARTIAL HAND, ROBIN-AIDS, THUMB REMAINING (OR EQUAL)                            Par hand robin-aids thum rem38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L601000100PPARTIAL HAND, ROBIN-AIDS, LITTLE AND/OR RING FINGER REMAINING (OR EQUAL)        Hand robin-aids little/ring 38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L602000100PPARTIAL HAND, ROBIN-AIDS, NO FINGER REMAINING (OR EQUAL)                        Part hand robin-aids no fing38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L602500100PTRANSCARPAL/METACARPAL OR PARTIAL HAND DISARTICULATION PROSTHESIS, EXTERNAL     Part hand disart myoelectric38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L602500200QPOWER, SELF-SUSPENDED, INNER SOCKET WITH REMOVABLE FOREARM SECTION, ELECTRODES                                                                                                                                                                                                                                       
L602500300QAND CABLES, TWO BATTERIES, CHARGER, MYOELECTRIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                           
L605000100PWRIST DISARTICULATION, MOLDED SOCKET, FLEXIBLE ELBOW HINGES, TRICEPS PAD        Wrst MLd sck flx hng tri pad38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L605500100PWRIST DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, FLEXIBLE ELBOW  Wrst mold sock w/exp interfa38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L605500200QHINGES, TRICEPS PAD                                                                                                                                                                                                                                                                                                  
L610000100PBELOW ELBOW, MOLDED SOCKET, FLEXIBLE ELBOW HINGE, TRICEPS PAD                   Elb mold sock flex hinge pad38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L611000100PBELOW ELBOW, MOLDED SOCKET, (MUENSTER OR NORTHWESTERN SUSPENSION TYPES)         Elbow mold sock suspension t38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L612000100PBELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STEP-UP HINGES, HALF CUFF         Elbow mold doub splt soc ste38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L613000100PBELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STUMP ACTIVATED LOCKING HINGE,    Elbow stump activated lock h38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L613000200QHALF CUFF                                                                                                                                                                                                                                                                                                            
L620000100PELBOW DISARTICULATION, MOLDED SOCKET, OUTSIDE LOCKING HINGE, FOREARM            Elbow mold outsid lock hinge38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L620500100PELBOW DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, OUTSIDE LOCKING Elbow molded w/ expand inter38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L620500200QHINGES, FOREARM                                                                                                                                                                                                                                                                                                      
L625000100PABOVE ELBOW, MOLDED DOUBLE WALL SOCKET, INTERNAL LOCKING ELBOW, FOREARM         Elbow inter loc elbow forarm38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L630000100PSHOULDER DISARTICULATION, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION,    Shlder disart int lock elbow38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L630000200QINTERNAL LOCKING ELBOW, FOREARM                                                                                                                                                                                                                                                                                      
L631000100PSHOULDER DISARTICULATION, PASSIVE RESTORATION (COMPLETE PROSTHESIS)             Shoulder passive restor comp38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L632000100PSHOULDER DISARTICULATION, PASSIVE RESTORATION (SHOULDER CAP ONLY)               Shoulder passive restor cap 38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L635000100PINTERSCAPULAR THORACIC, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION,      Thoracic intern lock elbow  38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L635000200QINTERNAL LOCKING ELBOW, FOREARM                                                                                                                                                                                                                                                                                      
L636000100PINTERSCAPULAR THORACIC, PASSIVE RESTORATION (COMPLETE PROSTHESIS)               Thoracic passive restor comp38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L637000100PINTERSCAPULAR THORACIC, PASSIVE RESTORATION (SHOULDER CAP ONLY)                 Thoracic passive restor cap 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L638000100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dsg cast chg wrst/elb38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L638000200QDRESSING, INCLUDING FITTING ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE                                                                                                                                                                                                                                          
L638000300QCAST CHANGE, WRIST DISARTICULATION OR BELOW ELBOW                                                                                                                                                                                                                                                                    
L638200100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING Postop dsg cast chg elb dis/38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L638200200QINCLUDING FITTING ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE CAST CHANGE,                                                                                                                                                                                                                                       
L638200300QELBOW DISARTICULATION OR ABOVE ELBOW                                                                                                                                                                                                                                                                                 
L638400100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING Postop dsg cast chg shlder/t38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L638400200QINCLUDING FITTING ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE CAST CHANGE,                                                                                                                                                                                                                                       
L638400300QSHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC                                                                                                                                                                                                                                                                   
L638600100PIMMEDIATE POST SURGICAL OR EARLY FITTING, EACH ADDITIONAL CAST CHANGE AND       Postop ea cast chg & realign38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L638600200QREALIGNMENT                                                                                                                                                                                                                                                                                                          
L638800100PIMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF RIGID DRESSING ONLY    Postop applicat rigid dsg on38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L640000100PBELOW ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC      Below elbow prosth tiss shap38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L640000200QTISSUE SHAPING                                                                                                                                                                                                                                                                                                       
L645000100PELBOW DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT       Elb disart prosth tiss shap 38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L645000200QPROSTHETIC TISSUE SHAPING                                                                                                                                                                                                                                                                                            
L650000100PABOVE ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC      Above elbow prosth tiss shap38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L650000200QTISSUE SHAPING                                                                                                                                                                                                                                                                                                       
L655000100PSHOULDER DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT    Shldr disar prosth tiss shap38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L655000200QPROSTHETIC TISSUE SHAPING                                                                                                                                                                                                                                                                                            
L657000100PINTERSCAPULAR THORACIC, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT      Scap thorac prosth tiss shap38      A                                                                                                     C                          D1F P       1984010119960101        N                           
L657000200QPROSTHETIC TISSUE SHAPING                                                                                                                                                                                                                                                                                            
L658000100PPREPARATORY, WRIST DISARTICULATION OR BELOW ELBOW, SINGLE WALL PLASTIC SOCKET,  Wrist/elbow bowden cable mol38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L658000200QFRICTION WRIST, FLEXIBLE ELBOW HINGES, FIGURE OF EIGHT HARNESS, HUMERAL CUFF,                                                                                                                                                                                                                                        
L658000300QBOWDEN CABLE CONTROL, USMC OR EQUAL PYLON, NO COVER, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                         
L658200100PPREPARATORY, WRIST DISARTICULATION OR BELOW ELBOW, SINGLE WALL SOCKET, FRICTION Wrist/elbow bowden cbl dir f38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L658200200QWRIST, FLEXIBLE ELBOW HINGES, FIGURE OF EIGHT HARNESS, HUMERAL CUFF, BOWDEN                                                                                                                                                                                                                                          
L658200300QCABLE CONTROL, USMC OR EQUAL PYLON, NO COVER, DIRECT FORMED                                                                                                                                                                                                                                                          
L658400100PPREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL PLASTIC SOCKET,  Elbow fair lead cable molded38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L658400200QFRICTION WRIST, LOCKING ELBOW, FIGURE OF EIGHT HARNESS, FAIR LEAD CABLE                                                                                                                                                                                                                                              
L658400300QCONTROL, USMC OR EQUAL PYLON, NO COVER, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                      
L658600100PPREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL SOCKET, FRICTION Elbow fair lead cable dir fo38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L658600200QWRIST, LOCKING ELBOW, FIGURE OF EIGHT HARNESS, FAIR LEAD CABLE CONTROL, USMC OR                                                                                                                                                                                                                                      
L658600300QEQUAL PYLON, NO COVER, DIRECT FORMED                                                                                                                                                                                                                                                                                 
L658800100PPREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL    Shdr fair lead cable molded 38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L658800200QPLASTIC SOCKET, SHOULDER JOINT, LOCKING ELBOW, FRICTION WRIST, CHEST STRAP,                                                                                                                                                                                                                                          
L658800300QFAIR LEAD CABLE CONTROL, USMC OR EQUAL PYLON, NO COVER, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                      
L659000100PPREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL    Shdr fair lead cable direct 38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L659000200QSOCKET, SHOULDER JOINT, LOCKING ELBOW, FRICTION WRIST, CHEST STRAP, FAIR LEAD                                                                                                                                                                                                                                        
L659000300QCABLE CONTROL, USMC OR EQUAL PYLON, NO COVER, DIRECT FORMED                                                                                                                                                                                                                                                          
L660000100PUPPER EXTREMITY ADDITIONS, POLYCENTRIC HINGE, PAIR                              Polycentric hinge pair      38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L660500100PUPPER EXTREMITY ADDITIONS, SINGLE PIVOT HINGE, PAIR                             Single pivot hinge pair     38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L661000100PUPPER EXTREMITY ADDITIONS, FLEXIBLE METAL HINGE, PAIR                           Flexible metal hinge pair   38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L661500100PUPPER EXTREMITY ADDITION,  DISCONNECT LOCKING WRIST UNIT                        Disconnect locking wrist uni38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L661600100PUPPER EXTREMITY ADDITION, ADDITIONAL DISCONNECT INSERT FOR LOCKING WRIST UNIT,  Disconnect insert locking wr38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L661600200QEACH                                                                                                                                                                                                                                                                                                                 
L662000100PUPPER EXTREMITY ADDITION,  FLEXION/EXTENSION WRIST UNIT, WITH OR WITHOUT        Flexion/extension wrist unit38      A                                                                                                     C                          D1F P       1986010120040101        N                           
L662000200QFRICTION                                                                                                                                                                                                                                                                                                             
L662100100PUPPER EXTREMITY PROSTHESIS ADDITION, FLEXION/EXTENSION WRIST WITH OR WITHOUT    Flex/ext wrist w/wo friction38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L662100200QFRICTION, FOR USE WITH EXTERNAL POWERED TERMINAL DEVICE                                                                                                                                                                                                                                                              
L662300100PUPPER EXTREMITY ADDITION,  SPRING ASSISTED ROTATIONAL WRIST UNIT WITH LATCH     Spring-ass rot wrst w/ latch38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L662300200QRELEASE                                                                                                                                                                                                                                                                                                              
L662500100PUPPER EXTREMITY ADDITION,  ROTATION WRIST UNIT WITH CABLE LOCK                  Rotation wrst w/ cable lock 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L662800100PUPPER EXTREMITY ADDITION,  QUICK DISCONNECT HOOK ADAPTER, OTTO BOCK OR EQUAL    Quick disconn hook adapter o38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L662900100PUPPER EXTREMITY ADDITION,  QUICK DISCONNECT LAMINATION COLLAR WITH COUPLING     Lamination collar w/ couplin38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L662900200QPIECE, OTTO BOCK OR EQUAL                                                                                                                                                                                                                                                                                            
L663000100PUPPER EXTREMITY ADDITION,  STAINLESS STEEL, ANY WRIST                           Stainless steel any wrist   38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L663200100PUPPER EXTREMITY ADDITION,  LATEX SUSPENSION SLEEVE, EACH                        Latex suspension sleeve each38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L663500100PUPPER EXTREMITY ADDITION,  LIFT ASSIST FOR ELBOW                                Lift assist for elbow       38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L663700100PUPPER EXTREMITY ADDITION,  NUDGE CONTROL ELBOW LOCK                             Nudge control elbow lock    38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L663800100PUPPER EXTREMITY ADDITION TO PROSTHESIS, ELECTRIC LOCKING FEATURE, ONLY FOR USE  Elec lock on manual pw elbow38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L663800200QWITH MANUALLY POWERED ELBOW                                                                                                                                                                                                                                                                                          
L664000100PUPPER EXTREMITY ADDITIONS, SHOULDER ABDUCTION JOINT, PAIR                       Shoulder abduction joint pai38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L664100100PUPPER EXTREMITY ADDITION,  EXCURSION AMPLIFIER, PULLEY TYPE                     Excursion amplifier pulley t38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L664200100PUPPER EXTREMITY ADDITION,  EXCURSION AMPLIFIER, LEVER TYPE                      Excursion amplifier lever ty38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L664500100PUPPER EXTREMITY ADDITION,  SHOULDER FLEXION-ABDUCTION JOINT, EACH               Shoulder flexion-abduction j38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L664600100PUPPER EXTREMITY ADDITION, SHOULDER JOINT, MULTIPOSITIONAL LOCKING, FLEXION,     Multipo locking shoulder jnt38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L664600200QADJUSTABLE ABDUCTION FRICTION CONTROL, FOR USE WITH BODY POWERED OR EXTERNAL                                                                                                                                                                                                                                         
L664600300QPOWERED SYSTEM                                                                                                                                                                                                                                                                                                       
L664700100PUPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, BODY POWERED ACTUATOR        Shoulder lock actuator      38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L664800100PUPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, EXTERNAL POWERED ACTUATOR    Ext pwrd shlder lock/unlock 38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L665000100PUPPER EXTREMITY ADDITION,  SHOULDER UNIVERSAL JOINT, EACH                       Shoulder universal joint    38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L665500100PUPPER EXTREMITY ADDITION,  STANDARD CONTROL CABLE, EXTRA                        Standard control cable extra38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L666000100PUPPER EXTREMITY ADDITION,  HEAVY DUTY CONTROL CABLE                             Heavy duty control cable    38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L666500100PUPPER EXTREMITY ADDITION,  TEFLON, OR EQUAL, CABLE LINING                       Teflon or equal cable lining38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L667000100PUPPER EXTREMITY ADDITION,  HOOK TO HAND, CABLE ADAPTER                          Hook to hand cable adapter  38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L667200100PUPPER EXTREMITY ADDITION,  HARNESS, CHEST OR SHOULDER, SADDLE TYPE              Harness chest/shlder saddle 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L667500100PUPPER EXTREMITY ADDITION, HARNESS, (E.G. FIGURE OF EIGHT TYPE), SINGLE CABLE    Harness figure of 8 sing con38      A                                                                                                     C                          D1F P       1986010120040101        N                           
L667500200QDESIGN                                                                                                                                                                                                                                                                                                               
L667600100PUPPER EXTREMITY ADDITION, HARNESS, (E.G. FIGURE OF EIGHT TYPE), DUAL CABLE      Harness figure of 8 dual con38      A                                                                                                     C                          D1F P       1986010120040101        N                           
L667600200QDESIGN                                                                                                                                                                                                                                                                                                               
L667700100PUPPER EXTREMITY ADDITION, HARNESS, TRIPLE CONTROL, SIMULTANEOUS OPERATION OF    UE triple control harness   38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L667700200QTERMINAL DEVICE AND ELBOW                                                                                                                                                                                                                                                                                            
L668000100PUPPER EXTREMITY ADDITION,  TEST SOCKET, WRIST DISARTICULATION OR BELOW ELBOW    Test sock wrist disart/bel e38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L668200100PUPPER EXTREMITY ADDITION,  TEST SOCKET, ELBOW DISARTICULATION OR ABOVE ELBOW    Test sock elbw disart/above 38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L668400100PUPPER EXTREMITY ADDITION,  TEST SOCKET, SHOULDER DISARTICULATION OR             Test socket shldr disart/tho38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L668400200QINTERSCAPULAR THORACIC                                                                                                                                                                                                                                                                                               
L668600100PUPPER EXTREMITY ADDITION,  SUCTION SOCKET                                       Suction socket              38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L668700100PUPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, BELOW ELBOW OR WRIST               Frame typ socket bel elbow/w38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L668700200QDISARTICULATION                                                                                                                                                                                                                                                                                                      
L668800100PUPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, ABOVE ELBOW OR ELBOW               Frame typ sock above elb/dis38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L668800200QDISARTICULATION                                                                                                                                                                                                                                                                                                      
L668900100PUPPER EXTREMITY ADDITION,  FRAME TYPE SOCKET, SHOULDER DISARTICULATION          Frame typ socket shoulder di38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L669000100PUPPER EXTREMITY ADDITION,  FRAME TYPE SOCKET, INTERSCAPULAR-THORACIC            Frame typ sock interscap-tho38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L669100100PUPPER EXTREMITY ADDITION,  REMOVABLE INSERT, EACH                               Removable insert each       38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L669200100PUPPER EXTREMITY ADDITION, SILICONE GEL INSERT OR EQUAL, EACH                    Silicone gel insert or equal38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L669300100PUPPER EXTREMITY ADDITION, LOCKING ELBOW, FOREARM COUNTERBALANCE                 Lockingelbow forearm cntrbal38      A                                                                                                     C                          D1F P       1999010120000101        N                           
L669400100PADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM         Elbow socket ins use w/lock 38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L669400200QFABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL,                                                                                                                                                                                                                                         
L669400300QELASTOMERIC OR EQUAL, FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                 
L669500100PADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM         Elbow socket ins use w/o lck38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L669500200QFABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL,                                                                                                                                                                                                                                         
L669500300QELASTOMERIC OR EQUAL, NOT FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                             
L669600100PADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM         Cus elbo skt in for con/atyp38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L669600200QFABRICATED SOCKET INSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE                                                                                                                                                                                                                                      
L669600300QGEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL                                                                                                                                                                                                                                        
L669600400QONLY (FOR OTHER THAN INITIAL, USE CODE L6694 OR L6695)                                                                                                                                                                                                                                                               
L669700100PADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM         Cus elbo skt in not con/atyp38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L669700200QFABRICATED SOCKET INSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC                                                                                                                                                                                                                                             
L669700300QAMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING                                                                                                                                                                                                                                         
L669700400QMECHANISM, INITIAL ONLY (FOR OTHER THAN INITIAL, USE CODE L6694 OR L6695)                                                                                                                                                                                                                                            
L669800100PADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, LOCK           Below/above elbow lock mech 38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L669800200QMECHANISM, EXCLUDES SOCKET INSERT                                                                                                                                                                                                                                                                                    
L670000100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #3                           Terminal device model #3    38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L670500100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #5                           Terminal device model #5    38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L671000100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #5X                          Terminal device model #5x   38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L671500100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #5XA                         Terminal device model #5xa  38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L672000100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #6                           Terminal device model #6    38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L672500100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #7                           Terminal device model #7    38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L673000100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #7LO                         Terminal device model #7lo  38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L673500100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #8                           Terminal device model #8    38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L674000100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #8X                          Terminal device model #8x   38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L674500100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #88X                         Terminal device model #88x  38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L675000100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #10P                         Terminal device model #10p  38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L675500100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #10X                         Terminal device model #10x  38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L676500100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #12P                         Terminal device model #12p  38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L677000100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #99X                         Terminal device model #99x  38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L677500100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #555                         Terminal device model#555   38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L678000100PTERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #SS555                       Terminal device model #ss55538      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L679000100PTERMINAL DEVICE,  HOOK-ACCU HOOK, OR EQUAL                                      Hooks-accu hook or equal    38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L679500100PTERMINAL DEVICE, HOOK-2 LOAD, OR EQUAL                                          Hooks-2 load or equal       38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L680000100PTERMINAL DEVICE, HOOK-APRL VC, OR EQUAL                                         Hooks-aprl vc or equal      38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L680500100PTERMINAL DEVICE, MODIFIER WRIST FLEXION UNIT                                    Modifier wrist flexion unit 38      A                  2133                                                                               D                          D1F P       1985010119960101        N                           
L680600100PTERMINAL DEVICE, HOOK, TRS GRIP, GRIP III, VC, OR EQUAL                         Trs grip vc or equal        38      A                  2133                                                                               D                          D1F P       1988010119970101        N                           
L680700100PTERMINAL DEVICE, HOOK, GRIP I, GRIP II, VC, OR EQUAL                            Term device grip1/2 or equal38      A                  2133                                                                               D                          D1F P       1988010119970101        N                           
L680800100PTERMINAL DEVICE, HOOK, TRS ADEPT, INFANT OR CHILD, VC, OR EQUAL                 Term device infant or child 38      A                  2133                                                                               D                          D1F P       1988010119970101        N                           
L680900100PTERMINAL DEVICE, HOOK, TRS SUPER SPORT, PASSIVE                                 Trs super sport passive     38      A                  2133                                                                               D                          D1F P       1988010119960101        N                           
L681000100PTERMINAL DEVICE, PINCHER TOOL, OTTO BOCK OR EQUAL                               Pincher tool otto bock or eq38      A                  2133                                                                               D                          D1F P       1988010119960101        N                           
L682500100PTERMINAL DEVICE, HAND, DORRANCE, VO                                             Hands dorrance vo           38      A                  2133                                                                               D                          D1F P       1982010119960101        N                           
L683000100PTERMINAL DEVICE, HAND, APRL, VC                                                 Hand aprl vc                38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L683500100PTERMINAL DEVICE, HAND, SIERRA, VO                                               Hand sierra vo              38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L684000100PTERMINAL DEVICE, HAND, BECKER IMPERIAL                                          Hand becker imperial        38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L684500100PTERMINAL DEVICE, HAND, BECKER LOCK GRIP                                         Hand becker lock grip       38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L685000100PTERMINAL DEVICE, HAND, BECKER PLYLITE                                           Term dvc-hand becker plylite38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L685500100PTERMINAL DEVICE, HAND, ROBIN-AIDS, VO                                           Hand robin-aids vo          38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L686000100PTERMINAL DEVICE, HAND, ROBIN-AIDS, VO SOFT                                      Hand robin-aids vo soft     38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L686500100PTERMINAL DEVICE, HAND, PASSIVE HAND                                             Hand passive hand           38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L686700100PTERMINAL DEVICE, HAND, DETROIT INFANT HAND (MECHANICAL)                         Hand detroit infant hand    38      A                  2133                                                                               D                          D1F P       1988010119960101        N                           
L686800100PTERMINAL DEVICE, HAND, PASSIVE INFANT HAND, (STEEPER, HOSMER OR EQUAL)          Passive inf hand steeper/hos38      A                  2133                                                                               D                          D1F P       1988010119960101        N                           
L687000100PTERMINAL DEVICE, HAND, CHILD MITT                                               Hand child mitt             38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L687200100PTERMINAL DEVICE, HAND, NYU CHILD HAND                                           Hand nyu child hand         38      A                  2133                                                                               D                          D1F P       1988010119960101        N                           
L687300100PTERMINAL DEVICE, HAND, MECHANICAL INFANT HAND, STEEPER OR EQUAL                 Hand mech inf steeper or equ38      A                  2133                                                                               D                          D1F P       1988010119960101        N                           
L687500100PTERMINAL DEVICE, HAND, BOCK, VC                                                 Hand bock vc                38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L688000100PTERMINAL DEVICE, HAND, BOCK, VO                                                 Hand bock vo                38      A                  2133                                                                               D                          D1F P       1986010119960101        N                           
L688100100PAUTOMATIC GRASP FEATURE, ADDITION TO UPPER LIMB PROSTHETIC TERMINAL DEVICE      Autograsp feature ul term dv38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L688200100PMICROPROCESSOR CONTROL FEATURE, ADDITION TO UPPER LIMB PROSTHETIC TERMINAL      Microprocessor control uplmb38      A                  2133                                                                               D                          D1F P       2002010120020101        N                           
L688200200QDEVICE                                                                                                                                                                                                                                                                                                               
L688300100PREPLACEMENT SOCKET, BELOW ELBOW/WRIST DISARTICULATION, MOLDED TO PATIENT MODEL, Replc sockt below e/w disa  38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L688300200QFOR USE WITH OR WITHOUT EXTERNAL POWER                                                                                                                                                                                                                                                                               
L688400100PREPLACEMENT SOCKET, ABOVE ELBOW DISARTICULATION, MOLDED TO PATIENT MODEL, FOR   Replc sockt above elbow disa38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L688400200QUSE WITH OR WITHOUT EXTERNAL POWER                                                                                                                                                                                                                                                                                   
L688500100PREPLACEMENT SOCKET, SHOULDER DISARTICULATION/INTERSCAPULAR THORACIC, MOLDED TO  Replc sockt shldr dis/interc38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L688500200QPATIENT MODEL, FOR USE WITH OR WITHOUT EXTERNAL POWER                                                                                                                                                                                                                                                                
L689000100PADDITION TO UPPER EXTREMITY PROSTHESIS, GLOVE FOR TERMINAL DEVICE, ANY          Prefab glove for term device38      A                                                                                                     C                          D1F P       1986010120050101        N                           
L689000200QMATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                             
L689500100PADDITION TO UPPER EXTREMITY PROSTHESIS, GLOVE FOR TERMINAL DEVICE, ANY          Custom glove for term device38      A                                                                                                     C                          D1F P       1986010120050101        N                           
L689500200QMATERIAL, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                          
L690000100PHAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH Hand restorat thumb/1 finger38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L690000200QGLOVE, THUMB OR ONE FINGER REMAINING                                                                                                                                                                                                                                                                                 
L690500100PHAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH Hand restoration multiple fi38      A                                                                                                     C                          D1F P       1986010119960101        N                           
L690500200QGLOVE, MULTIPLE FINGERS REMAINING                                                                                                                                                                                                                                                                                    
L691000100PHAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH Hand restoration no fingers 38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L691000200QGLOVE, NO FINGERS REMAINING                                                                                                                                                                                                                                                                                          
L691500100PHAND RESTORATION (SHADING, AND MEASUREMENTS INCLUDED), REPLACEMENT GLOVE FOR    Hand restoration replacmnt g38      A                                                                                                     C                          D1F P       1982010119960101        N                           
L691500200QABOVE                                                                                                                                                                                                                                                                                                                
L692000100PWRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE   Wrist disarticul switch ctrl38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L692000200QFOREARM SHELL, OTTO BOCK OR EQUAL, SWITCH, CABLES, TWO BATTERIES AND ONE                                                                                                                                                                                                                                             
L692000300QCHARGER, SWITCH CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                           
L692500100PWRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE   Wrist disart myoelectronic c38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L692500200QFOREARM SHELL, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE                                                                                                                                                                                                                                          
L692500300QCHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                    
L693000100PBELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM     Below elbow switch control  38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L693000200QSHELL, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH                                                                                                                                                                                                                                      
L693000300QCONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                                           
L693500100PBELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM     Below elbow myoelectronic ct38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L693500200QSHELL, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER,                                                                                                                                                                                                                                         
L693500300QMYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                             
L694000100PELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL   Elbow disarticulation switch38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L694000200QSHELL, OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO                                                                                                                                                                                                                                       
L694000300QBATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                         
L694500100PELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL   Elbow disart myoelectronic c38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L694500200QSHELL, OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES,                                                                                                                                                                                                                                       
L694500300QTWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                              
L695000100PABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL,      Above elbow switch control  38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L695000200QINTERNAL LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO                                                                                                                                                                                                                                              
L695000300QBATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                         
L695500100PABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL,      Above elbow myoelectronic ct38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L695500200QINTERNAL LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO                                                                                                                                                                                                                                          
L695500300QBATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                  
L696000100PSHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE        Shldr disartic switch contro38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L696000200QSHOULDER SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM,                                                                                                                                                                                                                                       
L696000300QOTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH                                                                                                                                                                                                                                             
L696000400QCONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                                           
L696500100PSHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE        Shldr disartic myoelectronic38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L696500200QSHOULDER SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM,                                                                                                                                                                                                                                       
L696500300QOTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER,                                                                                                                                                                                                                                                
L696500400QMYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                             
L697000100PINTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER Interscapular-thor switch ct38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L697000200QSHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK                                                                                                                                                                                                                                      
L697000300QOR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF                                                                                                                                                                                                                                            
L697000400QTERMINAL DEVICE                                                                                                                                                                                                                                                                                                      
L697500100PINTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER Interscap-thor myoelectronic38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L697500200QSHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK                                                                                                                                                                                                                                      
L697500300QOR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC                                                                                                                                                                                                                                            
L697500400QCONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                                           
L701000100PELECTRONIC HAND, OTTO BOCK, STEEPER OR EQUAL, SWITCH CONTROLLED                 Hand otto back steeper/eq sw38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L701500100PELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED     Hand sys teknik village swit38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L702000100PELECTRONIC GREIFER, OTTO BOCK OR EQUAL, SWITCH CONTROLLED                       Electronic greifer switch ct38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L702500100PELECTRONIC HAND, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED               Electron hand myoelectronic 38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L703000100PELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY     Hand sys teknik vill myoelec38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L703000200QCONTROLLED                                                                                                                                                                                                                                                                                                           
L703500100PELECTRONIC GREIFER, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED            Electron greifer myoelectro 38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L704000100PPREHENSILE ACTUATOR, HOSMER OR EQUAL, SWITCH CONTROLLED                         Prehensile actuator hosmer s38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L704500100PELECTRONIC HOOK, CHILD, MICHIGAN OR EQUAL, SWITCH CONTROLLED                    Electron hook child michigan38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L717000100PELECTRONIC ELBOW, HOSMER OR EQUAL, SWITCH CONTROLLED                            Electronic elbow hosmer swit38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L718000100PELECTRONIC ELBOW, MICROPROCESSOR SEQUENTIAL CONTROL OF ELBOW AND TERMINAL DEVICEElectronic elbow sequential 38      A                                                                                                     C                          D1F P       1988010120050101        N                           
L718100100PELECTRONIC ELBOW, MICROPROCESSOR SIMULTANEOUS CONTROL OF ELBOW AND TERMINAL     Electronic elbo simultaneous38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L718100200QDEVICE                                                                                                                                                                                                                                                                                                               
L718500100PELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED       Electron elbow adolescent sw38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L718600100PELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED            Electron elbow child switch 38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L719000100PELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY       Elbow adolescent myoelectron38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L719000200QCONTROLLED                                                                                                                                                                                                                                                                                                           
L719100100PELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED Elbow child myoelectronic ct38      A                                                                                                     C                          D1F P       1989010119960101        N                           
L726000100PELECTRONIC WRIST ROTATOR, OTTO BOCK OR EQUAL                                    Electron wrist rotator otto 38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L726100100PELECTRONIC WRIST ROTATOR, FOR UTAH ARM                                          Electron wrist rotator utah 38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L726600100PSERVO CONTROL, STEEPER OR EQUAL                                                 Servo control steeper or equ38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L727200100PANALOGUE CONTROL, UNB OR EQUAL                                                  Analogue control unb or equa38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L727400100PPROPORTIONAL CONTROL, 6-12 VOLT, LIBERTY, UTAH OR EQUAL                         Proportional ctl 12 volt uta38      A                                                                                                     C                          D1F P       1988010119970101        N                           
L736000100PSIX VOLT BATTERY, OTTO BOCK OR EQUAL, EACH                                      Six volt bat otto bock/eq ea38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L736200100PBATTERY CHARGER, SIX VOLT, OTTO BOCK OR EQUAL                                   Battery chrgr six volt otto 38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L736400100PTWELVE VOLT BATTERY, UTAH OR EQUAL, EACH                                        Twelve volt battery utah/equ38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L736600100PBATTERY CHARGER, TWELVE VOLT, UTAH OR EQUAL                                     Battery chrgr 12 volt utah/e38      A                                                                                                     C                          D1F P       1988010119960101        N                           
L736700100PLITHIUM ION BATTERY, REPLACEMENT                                                Replacemnt lithium ionbatter38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L736800100PLITHIUM ION BATTERY CHARGER                                                     Lithium ion battery charger 38      A                                                                                                     C                          D1F P       2003010120030101        N                           
L740000100PADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/WRIST DISARTICULATION,      Add UE prost be/wd, ultlite 38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L740000200QULTRALIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                
L740100100PADDITION TO UPPER EXTREMITY PROSTHESIS, ABOVE ELBOW DISARTICULATION, ULTRALIGHT Add UE prost a/e ultlite mat38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L740100200QMATERIAL (TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                           
L740200100PADDITION TO UPPER EXTREMITY PROSTHESIS, SHOULDER DISARTICULATION/INTERSCAPULAR  Add UE prost s/d ultlite mat38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L740200200QTHORACIC, ULTRALIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                      
L740300100PADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/WRIST DISARTICULATION,      Add UE prost b/e acrylic    38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L740300200QACRYLIC MATERIAL                                                                                                                                                                                                                                                                                                     
L740400100PADDITION TO UPPER EXTREMITY PROSTHESIS, ABOVE ELBOW DISARTICULATION, ACRYLIC    Add UE prost a/e acrylic    38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L740400200QMATERIAL                                                                                                                                                                                                                                                                                                             
L740500100PADDITION TO UPPER EXTREMITY PROSTHESIS, SHOULDER DISARTICULATION/INTERSCAPULAR  Add UE prost s/d acrylic    38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L740500200QTHORACIC, ACRYLIC MATERIAL                                                                                                                                                                                                                                                                                           
L749900100PUPPER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED                             Upper extremity prosthes NOS46      A                                                                                                     C                          D1F P       1985010119980101        N                           
L750000100PREPAIR OF PROSTHETIC DEVICE, HOURLY RATE (EXCLUDES V5335 REPAIR OF ORAL OR      Prosthetic dvc repair hourly46      A                  2100.4  2130D   2133                                                               D                          D1F P       1982010119960101        N                           
L750000200QLARYNGEAL PROSTHESIS OR ARTIFICIAL LARYNX)                                                                                                                                                                                                                                                                           
L751000100PREPAIR OF PROSTHETIC DEVICE, REPAIR OR REPLACE MINOR PARTS                      Prosthetic device repair rep46      A                  2100.4  2130D   2133                                                               D                          D1F P       1985010120030101        N                           
L752000100PREPAIR PROSTHETIC DEVICE, LABOR COMPONENT, PER 15 MINUTES                       Repair prosthesis per 15 min46      A                                                                                                     C                          D1F P       1997010120000101        N                           
L760000100PPROSTHETIC DONNING SLEEVE, ANY MATERIAL, EACH                                   Prosthetic donning sleeve   00      9                                          1862(1)(a)                                                 S                          D1F P       2006010120060101        A                           
L790000100PMALE VACUUM ERECTION SYSTEM                                                     Male vacuum erection system 38      A                                                                                                     C                          D1F P       1997010120030101        N                           
L800000100PBREAST PROSTHESIS, MASTECTOMY BRA                                               Mastectomy bra              38      A                  2130 A                                                                             D                          D1F P       1986010119960101        N                           
L800100100PBREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM,      Breast prosthesis bra & form38      A                  2130A                                                                              D                          D1F P       2002010120020101        N                           
L800100200QUNILATERAL                                                                                                                                                                                                                                                                                                           
L800200100PBREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM,      Brst prsth bra & bilat form 38      A                  2130A                                                                              D                          D1F P       2002010120020101        N                           
L800200200QBILATERAL                                                                                                                                                                                                                                                                                                            
L801000100PBREAST PROSTHESIS, MASTECTOMY SLEEVE                                            Mastectomy sleeve           00      9                  2130 A                                                                             D                          D1F P       1986010120050401        P                           
L801500100PEXTERNAL BREAST PROSTHESIS GARMENT, WITH MASTECTOMY FORM, POST MASTECTOMY       Ext breastprosthesis garment38      A                  2130                                                                               D                          D1F P       1999010119990101        N                           
L802000100PBREAST PROSTHESIS, MASTECTOMY FORM                                              Mastectomy form             38      A                  2130 A                                                                             D                          D1F P       1986010119960101        N                           
L803000100PBREAST PROSTHESIS, SILICONE OR EQUAL                                            Breast prosthesis silicone/e38      A                  2130 A                                                                             D                          D1F P       1989010119960101        N                           
L803500100PCUSTOM BREAST PROSTHESIS, POST MASTECTOMY, MOLDED TO PATIENT MODEL              Custom breast prosthesis    38      A                  2130                                                                               D                          D1F P       1999010119990101        N                           
L803900100PBREAST PROSTHESIS, NOT OTHERWISE SPECIFIED                                      Breast prosthesis NOS       46      A                                                                                                     C                          D1F P       1998010119980101        N                           
L804000100PNASAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                   Nasal prosthesis            38      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804100100PMIDFACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                               Midfacial prosthesis        38      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804200100PORBITAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                 Orbital prosthesis          38      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804300100PUPPER FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                            Upper facial prosthesis     38      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804400100PHEMI-FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                             Hemi-facial prosthesis      38      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804500100PAURICULAR PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                               Auricular prosthesis        38      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804600100PPARTIAL FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                          Partial facial prosthesis   38      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804700100PNASAL SEPTAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                            Nasal septal prosthesis     38      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804800100PUNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT, PROVIDED BY A NON-PHYSICIAN    Unspec maxillofacial prosth 46      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804900100PREPAIR OR MODIFICATION OF MAXILLOFACIAL PROSTHESIS, LABOR COMPONENT, 15 MINUTE  Repair maxillofacial prosth 46      A                                                                                                     C                          D1F P       2001010120010101        N                           
L804900200QINCREMENTS, PROVIDED BY A NON-PHYSICIAN                                                                                                                                                                                                                                                                              
L810000100PGRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH                     Compression stocking BK18-3000      960-9              2133                                                      A6530                    M                      0072D1F P       198601012006010120051231D                           
L811000100PGRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH                     Compression stocking BK30-4035      A                  2079                                                      A6531                    D                      0072D1A PS      198601012006010120051231D                           
L812000100PGRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH                     Compression stocking BK40-5035      A                  2079                                                      A6532                    D                      0072D1A PS      198601012006010120051231D                           
L813000100PGRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH                   Gc stocking thighlngth 18-3000      960-9              2133                                                      A6533                    M                      0072D1F P       198601012006010120051231D                           
L814000100PGRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH                   Gc stocking thighlngth 30-4000      960-9              2133                                                      A6534                    M                      0072D1F P       198601012006010120051231D                           
L815000100PGRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH                   Gc stocking thighlngth 40-5000      960-9              2133                                                      A6535                    M                      0072D1F P       198601012006010120051231D                           
L816000100PGRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH         Gc stocking full lngth 18-3000      960-9              2133                                                      A6536                    M                      0072D1F P       198601012006010120051231D                           
L817000100PGRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH         Gc stocking full lngth 30-4000      960-9              2133                                                      A6537                    M                      0072D1F P       198601012006010120051231D                           
L818000100PGRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH         Gc stocking full lngth 40-5000      960-9              2133                                                      A6538                    M                      0072D1F P       198601012006010120051231D                           
L819000100PGRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH                   Gc stocking waistlngth 18-3000      960-9              2133                                                      A6539                    M                      0072D1F P       198601012006010120051231D                           
L819500100PGRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH                   Gc stocking waistlngth 30-4000      960-9              2133                                                      A6540                    M                      0072D1F P       199901012006010120051231D                           
L820000100PGRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH                   Gc stocking waistlngth 40-5000      960-9              2133                                                      A6541                    M                      0072D1F P       198601012006010120051231D                           
L821000100PGRADIENT COMPRESSION  STOCKING, CUSTOM MADE                                     Gc stocking custom made     00      960-9              2133                                                      A6542                    M                          D1F P       198601012006010120051231D                           
L822000100PGRADIENT COMPRESSION STOCKING, LYMPHEDEMA                                       Gc stocking lymphedema      00      960-9              2133                                                      A6543                    M                          D1F P       198601012006010120051231D                           
L823000100PGRADIENT COMPRESSION STOCKING, GARTER BELT                                      Gc stocking garter belt     00      960-9              2133                                                      A6544                    M                          D1F P       198601012006010120051231D                           
L823900100PGRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED                          G compression stocking  NOS 46      A                                                                            A6549                    C                          D1F P       199801012006010120051231D                           
L830000100PTRUSS, SINGLE WITH STANDARD PAD                                                 Truss single w/ standard pad38      A70-1  70-2        2133                                                                               D                          D1F P       1986010119960101        N                           
L831000100PTRUSS, DOUBLE WITH STANDARD PADS                                                Truss double w/ standard pad38      A70-1  70-2        2133                                                                               D                          D1F P       1986010119960101        N                           
L832000100PTRUSS, ADDITION TO STANDARD PAD, WATER PAD                                      Truss addition to std pad wa38      A70-1  70-2        2133                                                                               D                          D1F P       1986010119960101        N                           
L833000100PTRUSS, ADDITION TO STANDARD PAD, SCROTAL PAD                                    Truss add to std pad scrotal38      A70-1  70-2        2133                                                                               D                          D1F P       1986010119960101        N                           
L840000100PPROSTHETIC SHEATH, BELOW KNEE, EACH                                             Sheath below knee           38      A                  2133                                                                               D                          D1F P       1982010119960101        N                           
L841000100PPROSTHETIC SHEATH, ABOVE KNEE, EACH                                             Sheath above knee           38      A                  2133                                                                               D                          D1F P       1982010119960101        N                           
L841500100PPROSTHETIC SHEATH, UPPER LIMB, EACH                                             Sheath upper limb           38      A                  2133                                                                               D                          D1F P       1988010119960101        N                           
L841700100PPROSTHETIC SHEATH/SOCK, INCLUDING A GEL CUSHION LAYER, BELOW KNEE OR ABOVE      Pros sheath/sock w gel cushn38      A                                                                                                     C                          D1F P       1997010119970101        N                           
L841700200QKNEE, EACH                                                                                                                                                                                                                                                                                                           
L842000100PPROSTHETIC SOCK, MULTIPLE PLY, BELOW KNEE, EACH                                 Prosthetic sock multi ply BK38      A                  2133                                                                               D                          D1F P       1982010119990101        N                           
L843000100PPROSTHETIC SOCK, MULTIPLE PLY, ABOVE KNEE, EACH                                 Prosthetic sock multi ply AK38      A                  2133                                                                               D                          D1F P       1982010119990101        N                           
L843500100PPROSTHETIC SOCK, MULTIPLE  PLY, UPPER LIMB, EACH                                Pros sock multi ply upper lm38      A                  2133                                                                               D                          D1F P       1988010120000101        N                           
L844000100PPROSTHETIC SHRINKER, BELOW KNEE, EACH                                           Shrinker below knee         38      A                  2133                                                                               D                          D1F P       1982010119960101        N                           
L846000100PPROSTHETIC SHRINKER, ABOVE KNEE, EACH                                           Shrinker above knee         38      A                  2133                                                                               D                          D1F P       1982010119960101        N                           
L846500100PPROSTHETIC SHRINKER, UPPER LIMB, EACH                                           Shrinker upper limb         38      A                  2133                                                                               D                          D1F P       1988010119960101        N                           
L847000100PPROSTHETIC SOCK, SINGLE PLY, FITTING, BELOW KNEE, EACH                          Pros sock single ply BK     38      A                  2133                                                                               D                          D1F P       1982010119990101        N                           
L848000100PPROSTHETIC SOCK, SINGLE PLY, FITTING, ABOVE KNEE, EACH                          Pros sock single ply AK     38      A                  2133                                                                               D                          D1F P       1982010119990101        N                           
L848500100PPROSTHETIC SOCK, SINGLE PLY, FITTING, UPPER LIMB, EACH                          Pros sock single ply upper l38      A                  2133                                                                               D                          D1F P       1994010119990101        N                           
L849000100PADDITION TO PROSTHETIC SHEATH/SOCK, AIR SEAL SUCTION RETENTION SYSTEM           Air seal suction reten systm38      A                                                                                                     C                          D1F P       199401012005010120041231N                           
L849900100PUNLISTED PROCEDURE FOR MISCELLANEOUS PROSTHETIC SERVICES                        Unlisted misc prosthetic ser46      A                                                                                                     C                          D1F P       1982010120020101        N                           
L850000100PARTIFICIAL LARYNX, ANY TYPE                                                     Artificial larynx           38      A65-5              2130                                                                               D                          D1F P       1990010119960101        N                           
L850100100PTRACHEOSTOMY SPEAKING VALVE                                                     Tracheostomy speaking valve 38      A65-16                                                                                                D                          D1F P       1990010119960101        N                           
L850500100PARTIFICIAL LARYNX REPLACEMENT BATTERY / ACCESSORY, ANY TYPE                     Artificial larynx, accessory46      A                                                                                                     C                          D1F P       2002010120020101        N                           
L850700100PTRACHEO-ESOPHAGEAL VOICE PROSTHESIS, PATIENT INSERTED, ANY TYPE, EACH           Trach-esoph voice pros pt in38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L850900100PTRACHEO-ESOPHAGEAL VOICE PROSTHESIS, INSERTED BY A LICENSED HEALTH CARE         Trach-esoph voice pros md in38      A                                                                                                     C                          D1F P       2002010120020101        N                           
L850900200QPROVIDER, ANY TYPE                                                                                                                                                                                                                                                                                                   
L851000100PVOICE AMPLIFIER                                                                 Voice amplifier             38      A65-5                                                                                                 D                          D1F P       2002010120020101        N                           
L851100100PINSERT FOR INDWELLING TRACHEOESOPHAGEAL PROSTHESIS, WITH OR WITHOUT VALVE,      Indwelling trach insert     38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L851100200QREPLACEMENT ONLY, EACH                                                                                                                                                                                                                                                                                               
L851200100PGELATIN CAPSULES OR EQUIVALENT, FOR USE WITH TRACHEOESOPHAGEAL VOICE            Gel cap for trach voice pros38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L851200200QPROSTHESIS, REPLACEMENT ONLY, PER 10                                                                                                                                                                                                                                                                                 
L851300100PCLEANING DEVICE USED WITH TRACHEOESOPHAGEAL VOICE PROSTHESIS, PIPET, BRUSH, OR  Trach pros cleaning device  38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L851300200QEQUAL, REPLACEMENT ONLY, EACH                                                                                                                                                                                                                                                                                        
L851400100PTRACHEOESOPHAGEAL PUNCTURE DILATOR, REPLACEMENT ONLY, EACH                      Repl trach puncture dilator 38      A                                                                                                     C                          D1F P       2004010120040101        N                           
L851500100PGELATIN CAPSULE, APPLICATION DEVICE FOR USE WITH TRACHEOESOPHAGEAL VOICE        Gel cap app device for trach37      A                                                                                                     C                          D1F P       2005010120050101        N                           
L851500200QPROSTHESIS, EACH                                                                                                                                                                                                                                                                                                     
L860000100PIMPLANTABLE BREAST PROSTHESIS, SILICONE OR EQUAL                                Implant breast silicone/eq  38      A35-47             2130                                                                               D                          D1F P       1992010119971001        N                           
L860300100PINJECTABLE BULKING AGENT, COLLAGEN IMPLANT, URINARY TRACT, 2.5 ML SYRINGE,      Collagen imp urinary 2.5 ml 38      A65.9                                                                                                 D                          D1F P       1995010120010101        N                           
L860300200QINCLUDES SHIPPING AND NECESSARY SUPPLIES                                                                                                                                                                                                                                                                             
L860600100PINJECTABLE BULKING AGENT, SYNTHETIC IMPLANT, URINARY TRACT, 1 ML SYRINGE,       Synthetic implnt urinary 1ml38      A65.9                                                                                                 D                          D1F P       2001010120010101        N                           
L860600200QINCLUDES SHIPPING AND NECESSARY SUPPLIES                                                                                                                                                                                                                                                                             
L860900100PARTIFICIAL CORNEA                                                               Artificial cornea           38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L861000100POCULAR IMPLANT                                                                  Ocular implant              38      A                  2130                                                                               D                          D1F P       1992010119971001        N                           
L861200100PAQUEOUS SHUNT                                                                   Aqueous shunt prosthesis    38      A                  2130                                                      Q0074                    D                          D1F P       1992010119971001        N                           
L861300100POSSICULA IMPLANT                                                                Ossicular implant           38      A                  2130                                                                               D                          D1F P       1992010119971001        N                           
L861400100PCOCHLEAR DEVICE/SYSTEM                                                          Cochlear device/system      38      A65-14             2130                                                                               D                          D1F P       1992010119960916        N                           
L861500100PHEADSET/HEADPIECE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT             Coch implant headset replace38      A65-14                                                                                                D                          D1F P       2005010120050101        N                           
L861600100PMICROPHONE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT                    Coch implant microphone repl38      A65-14                                                                                                D                          D1F P       2005010120050101        N                           
L861700100PTRANSMITTING COIL FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT             Coch implant trans coil repl38      A65-14                                                                                                D                          D1F P       2005010120050101        N                           
L861800100PTRANSMITTER CABLE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT             Coch implant tran cable repl38      A65-14                                                                                                D                          D1F P       2005010120050101        N                           
L861900100PCOCHLEAR IMPLANT EXTERNAL SPEECH PROCESSOR, REPLACEMENT                         Replace cochlear processor  38      A65-14                                                                                                D                          D1F P       1996010119960916        N                           
L862000100PLITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH     Repl lithium ion battery    00      9                                                                                                     I                          D1F P       200501012006010120051231D                           
L862100100PZINC AIR BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH        Repl zinc air battery       38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L862200100PALKALINE BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, ANY SIZE, REPLACEMENT,   Repl alkaline battery       38      A                                                                                                     C                          D1F P       2005010120050101        N                           
L862200200QEACH                                                                                                                                                                                                                                                                                                                 
L862300100PLITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR,      Lith ion batt CID,non-earlvl38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L862300200QOTHER THAN EAR LEVEL, REPLACEMENT, EACH                                                                                                                                                                                                                                                                              
L862400100PLITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, EAR  Lith ion batt CID, ear level38      A                                                                                                     C                          D1F P       2006010120060101        A                           
L862400200QLEVEL, REPLACEMENT, EACH                                                                                                                                                                                                                                                                                             
L863000100PMETACARPOPHALANGEAL JOINT IMPLANT                                               Metacarpophalangeal implant 38      A                  2130                                                                               D                          D1F P       1992010119971001        N                           
L863100100PMETACARPAL PHALANGEAL JOINT REPLACEMENT, TWO OR MORE PIECES, METAL (E.G.,       MCP joint repl 2 pc or more 38      A                  2130                                                                               D                          D1F P       2004010120040101        N                           
L863100200QSTAINLESS STEEL OR COBALT CHROME), CERAMIC-LIKE MATERIAL (E.G., PYROCARBON),                                                                                                                                                                                                                                         
L863100300QFOR SURGICAL IMPLANTATION (ALL SIZES, INCLUDES ENTIRE SYSTEM)                                                                                                                                                                                                                                                        
L864100100PMETATARSAL JOINT IMPLANT                                                        Metatarsal joint implant    38      A                  2130                                                                               D                          D1F P       1992010119971001        N                           
L864200100PHALLUX IMPLANT                                                                  Hallux implant              38      A                  2130                                                      Q0073                    D                          D1F P       1992010119971001        N                           
L865800100PINTERPHALANGEAL JOINT SPACER, SILICONE OR EQUAL, EACH                           Interphalangeal joint spacer38      A                  2130                                                                               D                          D1F P       1992010120040101        N                           
L865900100PINTERPHALANGEAL FINGER JOINT REPLACEMENT, 2 OR MORE PIECES, METAL (E.G.,        Interphalangeal joint repl  38      A                  2130                                                                               D                          D1F P       2004010120040101        N                           
L865900200QSTAINLESS STEEL OR COBALT CHROME), CERAMIC-LIKE MATERIAL (E.G., PYROCARBON) FOR                                                                                                                                                                                                                                      
L865900300QSURGICAL IMPLANTATION, ANY SIZE                                                                                                                                                                                                                                                                                      
L867000100PVASCULAR GRAFT MATERIAL, SYNTHETIC, IMPLANT                                     Vascular graft, synthetic   38      A                  2130                                                                               D                          D1F P       1992010119971001        N                           
L868000100PIMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH                                     Implt neurostim elctr each  38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L868100100PPATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE             Pt prgrm for implt neurostim38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L868100200QNEUROSTIMULATOR PULSE GENERATOR                                                                                                                                                                                                                                                                                      
L868200100PIMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER                             Implt neurostim radiofq rec 38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L868300100PRADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR  Radiofq trsmtr for implt neu38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L868300200QRADIOFREQUENCY RECEIVER                                                                                                                                                                                                                                                                                              
L868400100PRADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT      Radiof trsmtr implt scrl neu38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L868400200QNEUROSTIMULATOR RECEIVER FOR BOWEL AND BLADDER MANAGEMENT, REPLACEMENT                                                                                                                                                                                                                                               
L868500100PIMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, SINGLE ARRAY, RECHARGEABLE,        Implt nrostm pls gen sng rec38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L868500200QINCLUDES EXTENSION                                                                                                                                                                                                                                                                                                   
L868600100PIMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, SINGLE ARRAY, NON-RECHARGEABLE,    Implt nrostm pls gen sng non38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L868600200QINCLUDES EXTENSION                                                                                                                                                                                                                                                                                                   
L868700100PIMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, DUAL ARRAY, RECHARGEABLE, INCLUDES Implt nrostm pls gen dua rec38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L868700200QEXTENSION                                                                                                                                                                                                                                                                                                            
L868800100PIMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, DUAL ARRAY, NON-RECHARGEABLE,      Implt nrostm pls gen dua non38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L868800200QINCLUDES EXTENSION                                                                                                                                                                                                                                                                                                   
L868900100PEXTERNAL RECHARGING SYSTEM FOR IMPLANTED NEUROSTIMULATOR, REPLACEMENT ONLY      External recharging system  38      A65-8                                                                                                 D                          D1F P       2006010120060101        A                           
L869900100PPROSTHETIC IMPLANT, NOT OTHERWISE SPECIFIED                                     Prosthetic implant NOS      46      A                                                                                                     C                          D1F P       1998010119980101        N                           
L990000100PORTHOTIC AND PROSTHETIC SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER  O&P supply/accessory/service46      A                                                                                                     C                          D1F P       2000010120000101        N                           
L990000200QHCPCS "L" CODE                                                                                                                                                                                                                                                                                                       
M006400100PBRIEF OFFICE VISIT FOR THE SOLE PURPOSE OF MONITORING OR CHANGING DRUG          Visit for drug monitoring   11      A                  2476.3                                                                             D                          M5B 1       1992010119960101        N                           
M006400200QPRESCRIPTIONS USED IN THE TREATMENT OF MENTAL PSYCHONEUROTIC AND PERSONALITY                                                                                                                                                                                                                                         
M006400300QDISORDERS                                                                                                                                                                                                                                                                                                            
M007500100PCELLULAR THERAPY                                                                Cellular therapy            00      935-5                                                                                                 M                          Y2  1       1986010119960101        N                           
M007600100PPROLOTHERAPY                                                                    Prolotherapy                00      935-13                                                                                                M                          Y2  1       1986010119960101        N                           
M010000100PINTRAGASTRIC HYPOTHERMIA USING GASTRIC FREEZING                                 Intragastric hypothermia    00      935-65                                                                                                M                          P1G 1       1986010120040101        N                           
M030000100PIV CHELATION THERAPY (CHEMICAL ENDARTERECTOMY)                                  IV chelationtherapy         00      935-64                                                                                                M                          Y2  1       1986010119960101        N                           
M030100100PFABRIC WRAPPING OF ABDOMINAL ANEURYSM                                           Fabric wrapping of aneurysm 00      935-34                                                                                                M                          P1G 2       1986010120040101        N                           
P202800100PCEPHALIN FLOCULATION, BLOOD                                                     Cephalin floculation test   57      A50-34                                                                                                D                          T1H 5       1986010119900101        N                           
P202900100PCONGO RED, BLOOD                                                                Congo red blood test        57      A50-34                                                                                                D                          T1H 5       1986010119900101        N                           
P203100100PHAIR ANALYSIS (EXCLUDING ARSENIC)                                               Hair analysis               00      950-24                                                                                                M                          T1H 5       1986010119890101        N                           
P203300100PTHYMOL TURBIDITY, BLOOD                                                         Blood thymol turbidity      57      A50-34                                                                                                D                          T1H 5       1986010119900101        N                           
P203800100PMUCOPROTEIN, BLOOD (SEROMUCOID) (MEDICAL NECESSITY PROCEDURE)                   Blood mucoprotein           21      A50-34                                                                                                D                          T1H 5       1986010119930101        N                           
P300000100PSCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS, BY       Screen pap by tech w md supv21      A50-20                                               630                                              D                      0045T1H 5       1992010119950101        N                           
P300000200QTECHNICIAN UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                                               
P300100100PSCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS,          Screening pap smear by phys 1121    C50-20                                               630                                              D                      0045T1G 5       1992010120020101        N                           
P300100200QREQUIRING INTERPRETATION BY PHYSICIAN                                                                                                                                                                                                                                                                                
P700100100PCULTURE, BACTERIAL, URINE; QUANTITATIVE, SENSITIVITY STUDY                      Culture bacterial urine     00      9                                                    110                     CPT                      I                          T1H 5       1986010119960101        N                           
P901000100PBLOOD (WHOLE), FOR TRANSFUSION, PER UNIT                                        Whole blood for transfusion 52      A                  2455A                                                                              D                          T1H 0       1987010119870101        N                           
P901100100PBLOOD (SPLIT UNIT), SPECIFY AMOUNT                                              Blood split unit            52      A                  2455A                                                                              D                          T1H 0       1987010120010101        N                           
P901200100PCRYOPRECIPITATE, EACH UNIT                                                      Cryoprecipitate each unit   52      A                  2455 B                                                                             D                          T1H 9       1987010120010101        N                           
P901600100PRED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT                                  RBC leukocytes reduced      52      A                  2455 B                                                                             D                          T1H 0       1987010120010101        N                           
P901700100PFRESH FROZEN PLASMA (SINGLE DONOR), FROZEN WITHIN 8 HOURS OF COLLECTION, EACH   Plasma 1 donor frz w/in 8 hr52      A                  2455 B                                                                             D                          T1H 9       1987010120040101        N                           
P901700200QUNIT                                                                                                                                                                                                                                                                                                                 
P901900100PPLATELETS, EACH UNIT                                                            Platelets, each unit        52      A                  2455 B                                                                             D                          T1H 9       1987010120010101        N                           
P902000100PPLATELET RICH PLASMA, EACH UNIT                                                 Plaelet rich plasma unit    52      A                  2455 B                                                                             D                          T1H 9       1987010120010101        N                           
P902100100PRED BLOOD CELLS, EACH UNIT                                                      Red blood cells unit        52      A                  2455A                                                                              D                          T1H 0       1987010120010101        N                           
P902200100PRED BLOOD CELLS, WASHED, EACH UNIT                                              Washed red blood cells unit 52      A                  2455A                                                                              D                          T1H 0       1987010119870101        N                           
P902300100PPLASMA, POOLED MULTIPLE DONOR, SOLVENT/DETERGENT TREATED, FROZEN, EACH UNIT     Frozen plasma, pooled, sd   52      A                  2455 B                                                                             D                          T1H 9       2000010120010101        N                           
P903100100PPLATELETS, LEUKOCYTES REDUCED, EACH UNIT                                        Platelets leukocytes reduced52      A                  2455                                                                               D                          T1H 9       2001010120010101        N                           
P903200100PPLATELETS, IRRADIATED, EACH UNIT                                                Platelets, irradiated       52      A                  2455                                                                               D                          T1H 9       2001010120010101        N                           
P903300100PPLATELETS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT                            Platelets leukoreduced irrad52      A                  2455                                                                               D                          T1H 9       2001010120010101        N                           
P903400100PPLATELETS, PHERESIS, EACH UNIT                                                  Platelets, pheresis         52      A                  2455                                                                               D                          T1H 9       2001010120010101        N                           
P903500100PPLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT                              Platelet pheres leukoreduced52      A                  2455                                                                               D                          T1H 9       2001010120010101        N                           
P903600100PPLATELETS, PHERESIS, IRRADIATED, EACH UNIT                                      Platelet pheresis irradiated52      A                  2455                                                                               D                          T1H 9       2001010120010101        N                           
P903700100PPLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT                  Plate pheres leukoredu irrad52      A                  2455                                                                               D                          T1H 9       2001010120010101        N                           
P903800100PRED BLOOD CELLS, IRRADIATED, EACH UNIT                                          RBC irradiated              52      A                  2455                                                                               D                          T1H 0       2001010120010101        N                           
P903900100PRED BLOOD CELLS, DEGLYCEROLIZED, EACH UNIT                                      RBC deglycerolized          52      A                  2455                                                                               D                          T1H 0       2001010120010101        N                           
P904000100PRED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT                      RBC leukoreduced irradiated 52      A                  2455                                                                               D                          T1H 0       2001010120010101        N                           
P904100100PINFUSION, ALBUMIN (HUMAN), 5%, 50 ML                                            Albumin (human),5%, 50ml    52      A                                                                                                     C                          T1H 9       2001010120010101        N                           
P904300100PINFUSION, PLASMA PROTEIN FRACTION (HUMAN), 5%, 50 ML                            Plasma protein fract,5%,50ml52      A                  2455B                                                                              D                          T1H 9       2001010120010101        N                           
P904400100PPLASMA, CRYOPRECIPITATE REDUCED, EACH UNIT                                      Cryoprecipitatereducedplasma52      A                  2455.B                                                                             D                          T1H 9       2001010120010101        N                           
P904500100PINFUSION, ALBUMIN (HUMAN), 5%, 250 ML                                           Albumin (human), 5%, 250 ml 52      A                                                                                                     C                          Y2  9       2002010120020101        N                           
P904600100PINFUSION, ALBUMIN (HUMAN), 25%, 20 ML                                           Albumin (human), 25%, 20 ml 52      A                                                                                                     C                          Y2  9       2002010120020101        N                           
P904700100PINFUSION, ALBUMIN (HUMAN), 25%, 50 ML                                           Albumin (human), 25%, 50ml  52      A                                                                                                     C                          Y2  9       2002010120020101        N                           
P904800100PINFUSION, PLASMA PROTEIN FRACTION (HUMAN), 5%, 250ML                            Plasmaprotein fract,5%,250ml52      A                                                                                                     C                          Y2  9       2002010120020101        N                           
P905000100PGRANULOCYTES, PHERESIS, EACH UNIT                                               Granulocytes, pheresis unit 52      A                                                                                                     C                          Z2  9       2002010120020101        N                           
P905100100PWHOLE BLOOD OR RED BLOOD CELLS, LEUKOCYTES REDUCED, CMV-NEGATIVE, EACH UNIT     Blood, l/r, cmv-neg         52      A                                          1833T                                                      D                          T1H 0       2004010120040101        N                           
P905200100PPLATELETS, HLA-MATCHED LEUKOCYTES REDUCED, APHERESIS/PHERESIS, EACH UNIT        Platelets, hla-m, l/r, unit 52      A                                          1833T                                                      D                          T1H 9       2004010120040101        N                           
P905300100PPLATELETS, PHERESIS, LEUKOCYTES REDUCED, CMV-NEGATIVE, IRRADIATED, EACH UNIT    Plt, pher, l/r cmv-neg, irr 52      A                                          1833T                                                      D                          T1H 9       2004010120040101        N                           
P905400100PWHOLE BLOOD OR RED BLOOD CELLS, LEUKOCYTES REDUCED, FROZEN, DEGLYCEROL, WASHED, Blood, l/r, froz/degly/wash 52      A                                          1833T                                                      D                          T1H 0       2004010120040101        N                           
P905400200QEACH UNIT                                                                                                                                                                                                                                                                                                            
P905500100PPLATELETS, LEUKOCYTES REDUCED, CMV-NEGATIVE, APHERESIS/PHERESIS, EACH UNIT      Plt, aph/pher, l/r, cmv-neg 52      A                                          1833T                                                      D                          T1H 9       2004010120040101        N                           
P905600100PWHOLE BLOOD, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT                          Blood, l/r, irradiated      52      A                                          1833T                                                      D                          T1H 0       2004010120040101        N                           
P905700100PRED BLOOD CELLS, FROZEN/DEGLYCEROLIZED/WASHED, LEUKOCYTES REDUCED, IRRADIATED,  RBC, frz/deg/wsh, l/r, irrad52      A                                          1833T                                                      D                          T1H 0       2004010120040101        N                           
P905700200QEACH UNIT                                                                                                                                                                                                                                                                                                            
P905800100PRED BLOOD CELLS, LEUKOCYTES REDUCED, CMV-NEGATIVE, IRRADIATED, EACH UNIT        RBC, l/r, cmv-neg, irrad    52      A                                          1833T                                                      D                          T1H 0       2004010120040101        N                           
P905900100PFRESH FROZEN PLASMA BETWEEN 8-24 HOURS OF COLLECTION, EACH UNIT                 Plasma, frz between 8-24hour52      A                                          1833T                                                      D                          T1H 9       2004010120040101        N                           
P906000100PFRESH FROZEN PLASMA, DONOR RETESTED, EACH UNIT                                  Fr frz plasma donor retested52      A                                          1833T                                                      D                          T1H 9       2004010120040101        N                           
P960300100PTRAVEL ALLOWANCE ONE WAY IN CONNECTION WITH MEDICALLY NECESSARY LABORATORY      One-way allow prorated miles22      A                  51141K                                                                             D                      0039Y2  5       1987010119920101        N                           
P960300200QSPECIMEN COLLECTION DRAWN FROM HOME BOUND OR NURSING HOME BOUND PATIENT;                                                                                                                                                                                                                                             
P960300300QPRORATED MILES ACTUALLY TRAVELLED.                                                                                                                                                                                                                                                                                   
P960400100PTRAVEL ALLOWANCE ONE WAY IN CONNECTION WITH MEDICALLY NECESSARY LABORATORY      One-way allow prorated trip 22      A                  51141K                                                                             D                      0039Y2  5       1987010119920101        N                           
P960400200QSPECIMEN COLLECTION DRAWN FROM HOME BOUND OR NURSING HOME BOUND PATIENT;                                                                                                                                                                                                                                             
P960400300QPRORATED TRIP CHARGE.                                                                                                                                                                                                                                                                                                
P961200100PCATHETERIZATION FOR COLLECTION OF SPECIMEN, SINGLE PATIENT, ALL PLACES OF       Catheterize for urine spec  57      A                  5114.1D                                                                            D                          T1H 5       1999010119990101        N                           
P961200200QSERVICE                                                                                                                                                                                                                                                                                                              
P961500100PCATHETERIZATION FOR COLLECTION OF SPECIMEN (S) (MULTIPLE PATIENTS)              Urine specimen collect mult 57      A                  51141D                                                                             D                      0040T1H 5       1985010119920101        N                           
Q003500100PCARDIOKYMOGRAPHY                                                                Cardiokymography            11      A50-50                                                                                                D                          T2D 5       1989010119910101        N                           
Q008100100PINFUSION THERAPY, USING OTHER THAN CHEMOTHERAPEUTIC DRUGS, PER VISIT            Infusion ther other than che00      960-14                                                                                                D                      0041P6C 1       1992010119960101        N                           
Q008300100PCHEMOTHERAPY ADMINISTRATION BY OTHER THAN INFUSION TECHNIQUE ONLY (EG           Chemo by other than infusion00      9                                                                                                     C                      0041O1D 1       1992010119960101        N                           
Q008300200QSUBCUTANEOUS, INTRAMUSCULAR, PUSH), PER VISIT                                                                                                                                                                                                                                                                        
Q008400100PCHEMOTHERAPY ADMINISTRATION BY INFUSION TECHNIQUE ONLY, PER VISIT               Chemotherapy by infusion    00      960-14                                                                                                D                      0041O1D 1       1992010119960101        N                           
Q008500100PCHEMOTHERAPY ADMINISTRATION BY BOTH INFUSION TECHNIQUE AND OTHER TECHIQUE(S)    Chemo by both infusion and o00      9                                                                                                     C                      0041O1D 1       1992010119960101        N                           
Q008500200Q(EG SUBCUTANEOUS, INTRAMUSCULAR, PUSH), PER VISIT                                                                                                                                                                                                                                                                    
Q008600100PPHYSICAL THERAPY EVALUATION/TREATMENT, PER VISIT                                Physical therapy evaluation/00      9                  2210                                                                               D                      0049Z2  9       199201012004010120031231N                           
Q009100100PSCREENING PAPANICOLAOU SMEAR; OBTAINING, PREPARING AND CONVEYANCE OF CERVICAL   Obtaining screen pap smear  11      A50-20                                                                                                D                          P6C 1       1992010119960701        N                           
Q009100200QOR VAGINAL SMEAR TO LABORATORY                                                                                                                                                                                                                                                                                       
Q009200100PSET-UP PORTABLE X-RAY EQUIPMENT                                                 Set up port xray equipment  11      A                  2070.4                                                                             D                          I1F 4       1993010119960101        N                           
Q011100100PWET MOUNTS, INCLUDING PREPARATIONS OF VAGINAL, CERVICAL OR SKIN SPECIMENS       Wet mounts/ w preparations  21      A                                                    110120130                                        C                          T1H 5       1994010119940101        N                           
Q011200100PALL POTASSIUM HYDROXIDE (KOH) PREPARATIONS                                      Potassium hydroxide preps   21      A                                                    120                                              C                          T1H 5       1994010119940101        N                           
Q011300100PPINWORM EXAMINATIONS                                                            Pinworm examinations        21      A                                                    130                                              C                          T1H 5       1994010119940101        N                           
Q011400100PFERN TEST                                                                       Fern test                   21      A                                                    310                                              C                          T1H 5       1994010119940101        N                           
Q011500100PPOST-COITAL DIRECT, QUALITATIVE EXAMINATIONS OF VAGINAL OR CERVICAL MUCOUS      Post-coital mucous exam     21      A                                                    400                                              C                          T1H 5       1994010119940101        N                           
Q013600100PINJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000 UNITS                    Non esrd epoetin alpha inj  51      A                  2049                                                      J0885                    D                          O1E 9       200012312006010120051231D                           
Q013700100PINJECTION, DARBEPOETIN ALFA, 1 MCG (NON-ESRD USE)                               Darbepoetin alfa, non-esrd  57      A                  4273.1                                                    J0881                    D                          O1E 1L      200401012006010120051231D                           
Q014400100PAZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM                           Azithromycin dihydrate, oral00      9                                                                                                     M                      0054O1E 1       1996070120020701        N                           
Q016300100PDIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION           Diphenhydramine HCl 50mg    51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q016300200QANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q016300300QAT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                             
Q016400100PPROCHLORPERAZINE MALEATE, 5  MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,   Prochlorperazine maleate 5mg51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q016400200QFOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q016400300QOF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q016500100PPROCHLORPERAZINE MALEATE, 10  MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,  Prochlorperazine maleate10mg51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q016500200QFOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q016500300QOF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q016600100PGRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,   Granisetron HCl 1 mg oral   51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q016600200QFOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q016600300QOF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 24 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q016700100PDRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A   Dronabinol 2.5mg oral       51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q016700200QCOMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                 
Q016700300QCHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q016800100PDRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A     Dronabinol 5mg oral         51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q016800200QCOMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                 
Q016800300QCHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q016900100PPROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRESCRIPTION            Promethazine HCl 12.5mg oral51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q016900200QANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q016900300QAT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q017000100PPROMETHAZINE HYDROCHLORIDE, 25  MG, ORAL, FDA APPROVED PRESCRIPTION             Promethazine HCl 25 mg oral 51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017000200QANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q017000300QAT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q017100100PCHLORPROMAZINE HYDROCHLORIDE, 10  MG, ORAL, FDA APPROVED PRESCRIPTION           Chlorpromazine HCl 10mg oral51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017100200QANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q017100300QAT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q017200100PCHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION            Chlorpromazine HCl 25mg oral51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017200200QANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q017200300QAT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q017300100PTRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED PRESCRIPTION        Trimethobenzamide HCl 250mg 51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017300200QANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q017300300QAT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q017400100PTHIETHYLPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,   Thiethylperazine maleate10mg51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017400200QFOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q017400300QOF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q017500100PPERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A   Perphenazine 4mg oral       51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017500200QCOMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                 
Q017500300QCHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q017600100PPERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A    Perphenazine 8mg oral       51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017600200QCOMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                 
Q017600300QCHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q017700100PHYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR    Hydroxyzine pamoate 25mg    51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017700200QUSE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                        
Q017700300QCHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q017800100PHYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR    Hydroxyzine pamoate 50mg    51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017800200QUSE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                        
Q017800300QCHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q017900100PONDANSETRON HYDROCHLORIDE 8  MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,   Ondansetron HCl 8mg oral    51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q017900200QFOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q017900300QOF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q018000100PDOLASETRON MESYLATE, 100  MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR  Dolasetron mesylate oral    51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q018000200QUSE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                        
Q018000300QCHEMOTHERAPY TREATMENT, NOT TO EXCEED A 24 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q018100100PUNSPECIFIED ORAL DOSAGE FORM, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS Unspecified oral anti-emetic51      A                                          4557                                                       D                          O1D 1       1998040119980401        N                           
Q018100200QA COMPLETE THERAPEUTIC SUBSTITUTE FOR A IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                
Q018100300QCHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q018200100PDERMAL AND EPIDERMAL, TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER         Nonmetabolic act d/e tissue 51      A                                                                            J7343                    C                          Z2  S       200401012005010120041231N                           
Q018200200QBIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER                                                                                                                                                                                                                                      
Q018200300QSQUARE CENTIMETER                                                                                                                                                                                                                                                                                                    
Q018300100PDERMAL TISSUE, OF HUMAN ORIGIN, WITH AND WITHOUT OTHER BIOENGINEERED OR         Nonmetabolic active tissue  51      A                                                                            J7344                    C                          O1E S       199901012005010120041231N                           
Q018300200QPROCESSED ELEMENTS, BUT WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE                                                                                                                                                                                                                                            
Q018300300QCENTIMETER                                                                                                                                                                                                                                                                                                           
Q018400100PDERMAL TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR          Metabolically active tissue 51      A                                                                            J7342                    C                          O1E S       199901012003010120021231N                           
Q018400200QPROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER                                                                                                                                                                                                                                        
Q018700100PFACTOR VIIA (COAGULATION FACTOR, RECOMBINANT) PER 1.2 MG                        Factor viia recombinant     51      A                  2049                                                      J7189                    D                          O1E 1P      200001012006010120051231D                           
Q048000100PDRIVER FOR USE WITH PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY       Driver pneumatic vad, rep   38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048100100PMICROPROCESSOR CONTROL UNIT FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,    Microprcsr cu elec vad, rep 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048100200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q048200100PMICROPROCESSOR CONTROL UNIT FOR USE WITH ELECTRIC/PNEUMATIC COMBINATION         Microprcsr cu combo vad, rep38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048200200QVENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                          
Q048300100PMONITOR/DISPLAY MODULE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,         Monitor elec vad, rep       38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048300200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q048400100PMONITOR/DISPLAY MODULE FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR  Monitor elec or comb vad rep38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048400200QASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                      
Q048500100PMONITOR CONTROL CABLE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,          Monitor cable elec vad, rep 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048500200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q048600100PMONITOR CONTROL CABLE FOR USE WITH ELECTRIC/PNEUMATIC VENTRICULAR ASSIST        Mon cable elec/pneum vad rep38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048600200QDEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q048700100PLEADS (PNEUMATIC/ELECTRICAL) FOR USE WITH ANY TYPE ELECTRIC/PNEUMATIC           Leads any type vad, rep only38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048700200QVENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                          
Q048800100PPOWER PACK BASE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE, REPLACEMENT    Pwr pack base elec vad, rep 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048800200QONLY                                                                                                                                                                                                                                                                                                                 
Q048900100PPOWER PACK BASE FOR USE WITH ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,      Pwr pck base combo vad, rep 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q048900200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q049000100PEMERGENCY POWER SOURCE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,         Emr pwr source elec vad, rep38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049000200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q049100100PEMERGENCY POWER SOURCE FOR USE WITH ELECTRIC/PNEUMATIC VENTRICULAR ASSIST       Emr pwr source combo vad rep38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049100200QDEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q049200100PEMERGENCY POWER SUPPLY CABLE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,   Emr pwr cbl elec vad, rep   38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049200200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q049300100PEMERGENCY POWER SUPPLY CABLE FOR USE WITH ELECTRIC/PNEUMATIC VENTRICULAR ASSIST Emr pwr cbl combo vad, rep  38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049300200QDEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q049400100PEMERGENCY HAND PUMP FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR     Emr hd pmp elec/combo, rep  38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049400200QASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                      
Q049500100PBATTERY/POWER PACK CHARGER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC          Charger elec/combo vad, rep 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049500200QVENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                          
Q049600100PBATTERY FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,  Battery elec/combo vad, rep 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049600200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q049700100PBATTERY CLIPS FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST    Bat clps elec/comb vad, rep 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049700200QDEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q049800100PHOLSTER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,  Holster elec/combo vad, rep 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049800200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q049900100PBELT/VEST FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST        Belt/vest elec/combo vad rep38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q049900200QDEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q050000100PFILTERS FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,  Filters elec/combo vad, rep 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q050000200QREPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q050100100PSHOWER COVER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST     Shwr cov elec/combo vad, rep38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q050100200QDEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q050200100PMOBILITY CART FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY         Mobility cart pneum vad, rep38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q050300100PBATTERY FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY, EACH         Battery pneum vad replacemnt38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q050400100PPOWER ADAPTER FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY,        Pwr adpt pneum vad, rep veh 38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q050400200QVEHICLE TYPE                                                                                                                                                                                                                                                                                                         
Q050500100PMISCELLANEOUS SUPPLY OR ACCESSORY FOR USE WITH VENTRICULAR ASSIST DEVICE        Miscl supply/accessory vad  38      A                                                                                                     D                      0121D1F P       2005100120051001        A                           
Q051000100PPHARMACY SUPPLY FEE FOR INITIAL IMMUNOSUPPRESSIVE DRUG(S), FIRST MONTH          Dispens fee immunosupressive46      A                                                                                                     D                      0129O1E 9       2006010120060101        A                           
Q051000200QFOLLOWING TRANSPLANT                                                                                                                                                                                                                                                                                                 
Q051100100PPHARMACY SUPPLY FEE FOR ORAL ANTI-CANCER, ORAL ANTI-EMETIC OR IMMUNOSUPPRESSIVE Sup fee antiem,antica,immuno46      A                                                                                                     D                      0129O1E 9       2006010120060101        A                           
Q051100200QDRUG(S); FOR THE FIRST PRESCRIPTION IN A 30-DAY PERIOD                                                                                                                                                                                                                                                               
Q051200100PPHARMACY SUPPLY FEE FOR ORAL ANTI-CANCER, ORAL ANTI-EMETIC OR IMMUNOSUPPRESSIVE Px sup fee anti-can sub pres46      A                                                                                                     D                      0129D1G 9       2006010120060101        A                           
Q051200200QDRUG(S); FOR A SUBSEQUENT PRESCRIPTION IN A 30-DAY PERIOD                                                                                                                                                                                                                                                            
Q051300100PPHARMACY DISPENSING FEE FOR INHALATION DRUG(S); PER 30 DAYS                     Disp fee inhal drugs/30 days46      A                                                                                                     D                      0129O1E 9       2006010120060101        A                           
Q051400100PPHARMACY DISPENSING FEE FOR INHALATION DRUG(S); PER 90 DAYS                     Disp fee inhal drugs/90 days46      A                                                                                                     D                      0129O1E 9       2006010120060101        A                           
Q051500100PINJECTION, SERMORELIN ACETATE, 1 MICROGRAM                                      Sermorelin acetate injection51      A                  2049                                                                               D                          O1E 1P      2006010120060101        A                           
Q100100100PNEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 1 AS DEFINED IN FEDERAL REGISTER       Ntiol category 1            57      A                                                                                                     D                      0086D1F F       199907012005070120050630D                           
Q100100200QNOTICE, VOL 65, DATED MAY 3, 2000                                                                                                                                                                                                                                                                                    
Q100200100PNEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 2 AS DEFINED IN FEDERAL REGISTER       Ntiol category 2            57      A                                                                                                     D                      0086D1F F       199907012005070120050630D                           
Q100200200QNOTICE, VOL 65, DATED MAY 3, 2000                                                                                                                                                                                                                                                                                    
Q100300100PNEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 3 AS DEFINED IN FEDERAL REGISTER NOTICENtiol category 3            57      A                                                                                                     D                      0086D1F F       1999070120031001        N                           
Q100400100PNEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 4 AS DEFINED IN FEDERAL REGISTER NOTICENtiol category 4            57      A                                                                                                     D                      0086D1F F       1999070120031001        N                           
Q100500100PNEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 5 AS DEFINED IN FEDERAL REGISTER NOTICENtiol category 5            57      A                                                                                                     D                      0086D1F F       1999070120031001        N                           
Q200100100PORAL, CABERGOLINE, 0.5 MG                                                       Oral cabergoline 0.5 mg     00      9                  2049.5                                                                             M                          O1E 1P      200007012006010120051231D                           
Q200200100PINJECTION, ELLIOTTS B SOLUTION, PER ML                                          Elliotts b solution per ml  51      A                  2049                    1861S2B                           J9175                    D                      0095O1E 1P      200007012006010120051231D                           
Q200300100PINJECTION, APROTININ, 10,000 KIU                                                Aprotinin, 10,000 kiu       51      A                  2049                    1861S2B                           J0365                    D                      0095O1E 1P      200007012006010120051231D                           
Q200400100PIRRIGATION SOLUTION FOR TREATMENT OF BLADDER CALCULI, FOR EXAMPLE RENACIDIN,    Bladder calculi irrig sol   51      A                  2049                    1861S2B                                                    D                      0095O1E 1P      2000070120000701        N                           
Q200400200QPER 500 ML                                                                                                                                                                                                                                                                                                           
Q200500100PINJECTION, CORTICORELIN OVINE TRIFLUTATE, PER DOSE                              Corticorelin ovine triflutat51      A                  2049                    1861S2B                                                    D                      0095O1E 1P      200007012006010120051231D                           
Q200600100PINJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL                                 Digoxin immune fab (ovine)  51      A                  2049                    1861S2B                           J1162                    D                      0095O1E 1P      200007012006010120051231D                           
Q200700100PINJECTION, ETHANOLAMINE OLEATE, 100 MG                                          Ethanolamine oleate 100 mg  51      A                  2049                    1861S2B                           J1430                    D                      0095O1E 1P      200007012006010120051231D                           
Q200800100PINJECTION, FOMEPIZOLE, 15 MG                                                    Fomepizole, 15 mg           51      A                  2049                    1861S2B                           J1451                    D                      0095O1E 1P      200007012006010120051231D                           
Q200900100PINJECTION, FOSPHENYTOIN, 50 MG                                                  Fosphenytoin, 50 mg         51      A                  2049                    1861S2B                                                    D                      0095O1E 1P      2000070120000701        N                           
Q201000100PINJECTION, GLATIRAMER ACETATE, PER DOSE                                         Glatiramer acetate, per dose51      A                  2049                    1861S2B                                                    D                      0095O1E 1P      200007012004010120031231N                           
Q201100100PINJECTION, HEMIN, PER 1 MG                                                      Hemin, per 1 mg             51      A                  2049                    1861S2B                           J1640                    D                      0095O1E 1P      200007012006010120051231D                           
Q201200100PINJECTION, PEGADEMASE BOVINE, 25 IU                                             Pegademase bovine, 25 iu    51      A                  2049                    1861S2B                           J2504                    D                      0095O1E 1P      200007012006010120051231D                           
Q201300100PINJECTION, PENTASTARCH, 10% SOLUTION, PER 100 ML                                Pentastarch 10% solution    51      A                  2049                    1861S2B                           J2513                    D                      0095O1E 1P      200007012006010120051231D                           
Q201400100PINJECTION, SERMORELIN ACETATE, 0.5 MG                                           Sermorelin acetate, 0.5 mg  51      A                  2049                    1861S2B                                                    D                      0095O1E 1P      200007012006010120051231D                           
Q201700100PINJECTION, TENIPOSIDE, 50 MG                                                    Teniposide, 50 mg           51      A                  2049                    1861S2B                                                    D                      0095O1D 1P      2000070120000701        N                           
Q201800100PINJECTION, UROFOLLITROPIN, 75 IU                                                Urofollitropin, 75 iu       51      A                  2049                    1861S2B                           J3355                    D                      0095O1E 1P      200007012006010120051231D                           
Q201900100PINJECTION, BASILIXIMAB, 20 MG                                                   Basiliximab                 51      A                  2049                                                      J0480                    D                      0095O1E 1G      200007012006010120051231D                           
Q202000100PINJECTION, HISTRELIN ACETATE, 10 MCG                                            Histrelin acetate           51      A                  2049                    1861S2B                           J1675                    D                      0095O1E 1P      200007012006010120051231D                           
Q202100100PINJECTION, LEPIRUDIN, 50 MG                                                     Lepirudin                   51      A                  2049                    1861S2B                           J1945                    D                      0095O1E 1P      200007012006010120051231D                           
Q202200100PVON WILLEBRAND FACTOR COMPLEX, HUMAN, PER IU                                    VonWillebrandFactrCmplxperIU51      A35.30             2049.5                                                    J7188                    D                      0095O1E 1P      200007012006010120051231D                           
Q300000100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, RUBIDIUM RB-82, PER DOSERubidium RB-82              99      9                                                                                                     D                      0093I1E 4       200301012006010120051231D                           
Q300100100PRADIOELEMENTS FOR BRACHYTHERAPY, ANY TYPE, EACH                                 Brachytherapy Radioelements 57      A                  15022                                                                              D                          P7A 1       2000070120050101        F                           
Q300200100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, GALLIUM GA 67, PER MCI  Gallium ga 67               57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q300300100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M        Technetium tc99m bicisate   57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q300300200QBICISATE, PER UNIT DOSE                                                                                                                                                                                                                                                                                              
Q300400100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, XENON XE 133, PER 10 MCIXenon xe 133                57      A                  15022                                                                              D                          I1E 4       200007012006010120051231D                           
Q300500100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetium tc99m mertiatide 57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q300500200QMERTIATIDE, PER MCI                                                                                                                                                                                                                                                                                                  
Q300600100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       Technetium tc99m glucepatate57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q300600200QGLUCEPATATE, PER 5 MCI                                                                                                                                                                                                                                                                                               
Q300700100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM PHOSPHATE P32,   Sodium phosphate p32        57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q300700200QPER MCI                                                                                                                                                                                                                                                                                                              
Q300800100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111-IN           Indium 111-in pentetreotide 57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q300800200QPENTETREOTIDE, PER 3 MCI                                                                                                                                                                                                                                                                                             
Q300900100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M        Technetium tc99m oxidronate 57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q300900200QOXIDRONATE, PER MCI                                                                                                                                                                                                                                                                                                  
Q301000100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M -      Technetium tc99mlabeledrbcs 57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q301000200QLABELED RED BLOOD CELLS, PER MCI                                                                                                                                                                                                                                                                                     
Q301100100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CHROMIC PHOSPHATE P32   Chromic phosphate p32       57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q301100200QSUSPENSION, PER MCI                                                                                                                                                                                                                                                                                                  
Q301200100PSUPPLY OF ORAL RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CYANOCOBALAMIN     Cyanocobalamin cobalt co57  57      A                  15022                                                                              D                      0095I1E 4       200007012006010120051231D                           
Q301200200QCOBALT CO57, PER 0.5 MCI                                                                                                                                                                                                                                                                                             
Q301400100PTELEHEALTH ORIGINATING SITE FACILITY FEE                                        Telehealth facility fee     53      A                                                                                                     C                          Y2  9       2001100120011001        N                           
Q301700100PAMBULANCE SERVICE, ADVANCED LIFE SUPPORT (ALS) ASSESSMENT, NO OTHER ALS         ALS assessment              52      A                                                                                                     C                          O1A D       200201012003010120021231N                           
Q301700200QSERVICES PROVIDED                                                                                                                                                                                                                                                                                                    
Q301900100PALS VEHICLE USED, EMERGENCY TRANSPORT, NO ALS LEVEL SERVICES FURNISHED          ALS emer trans no ALS serv  52      A                                                                                                     C                          O1A D       2002040120020401        N                           
Q302000100PALS VEHICLE USED, NON-EMERGENCY TRANSPORT, NO ALS LEVEL SERVICE FURNISHED       ALS nonemer trans no ALS ser52      A                                                                                                     C                          O1A D       2002040120020401        N                           
Q302500100PINJECTION, INTERFERON BETA-1A, 11 MCG FOR INTRAMUSCULAR USE                     IM inj interferon beta 1-a  51      A                  2049                                                                               D                          O1E 1P      2003010120030101        N                           
Q302600100PINJECTION, INTERFERON BETA-1A, 11 MCG FOR SUBCUTANEOUS USE                      Subc inj interferon beta-1a 00      9                                                                                                     I                          O1E 1P      2003010120030101        N                           
Q303000100PSODIUM HYALURONATE PER 20 TO 25 MG DOSE, FOR INTRA-ARTICULAR INJECTION          Sodium hyaluronate 20-25 mg 51      A                                                                            J7317                    C                          O1E 1P      200207012003010120021231N                           
Q303100100PCOLLAGEN SKIN TEST                                                              Collagen skin test          11      A65-9                                                                                                 D                          D1A 5       2003040120041001        N                           
Q400100100PCASTING SUPPLIES, BODY CAST ADULT, WITH OR WITHOUT HEAD, PLASTER                Cast sup body cast plaster  52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q400200100PCAST SUPPLIES, BODY CAST ADULT, WITH OR WITHOUT HEAD, FIBERGLASS                Cast sup body cast fiberglas52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q400300100PCAST SUPPLIES, SHOULDER CAST, ADULT (11 YEARS +), PLASTER                       Cast sup shoulder cast plstr52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q400400100PCAST SUPPLIES, SHOULDER CAST, ADULT (11 YEARS +), FIBERGLASS                    Cast sup shoulder cast fbrgl52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q400500100PCAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), PLASTER                       Cast sup long arm adult plst52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q400600100PCAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), FIBERGLASS                    Cast sup long arm adult fbrg52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q400700100PCAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER                   Cast sup long arm ped plster52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q400800100PCAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS                Cast sup long arm ped fbrgls52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q400900100PCAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), PLASTER                      Cast sup sht arm adult plstr52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401000100PCAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), FIBERGLASS                   Cast sup sht arm adult fbrgl52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401100100PCAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER                  Cast sup sht arm ped plaster52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401200100PCAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS               Cast sup sht arm ped fbrglas52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401300100PCAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS Cast sup gauntlet plaster   52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401300200Q+), PLASTER                                                                                                                                                                                                                                                                                                          
Q401400100PCAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS Cast sup gauntlet fiberglass52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401400200Q+), FIBERGLASS                                                                                                                                                                                                                                                                                                       
Q401500100PCAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), PEDIATRIC (0-10 Cast sup gauntlet ped plster52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401500200QYEARS), PLASTER                                                                                                                                                                                                                                                                                                      
Q401600100PCAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), PEDIATRIC (0-10 Cast sup gauntlet ped fbrgls52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401600200QYEARS), FIBERGLASS                                                                                                                                                                                                                                                                                                   
Q401700100PCAST SUPPLIES, LONG ARM SPLINT, ADULT (11 YEARS +), PLASTER                     Cast sup lng arm splint plst52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401800100PCAST SUPPLIES, LONG ARM SPLINT, ADULT (11 YEARS +), FIBERGLASS                  Cast sup lng arm splint fbrg52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q401900100PCAST SUPPLIES, LONG ARM SPLINT, PEDIATRIC (0-10 YEARS), PLASTER                 Cast sup lng arm splnt ped p52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402000100PCAST SUPPLIES, LONG ARM SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS              Cast sup lng arm splnt ped f52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402100100PCAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YEARS +), PLASTER                    Cast sup sht arm splint plst52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402200100PCAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YEARS +), FIBERGLASS                 Cast sup sht arm splint fbrg52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402300100PCAST SUPPLIES, SHORT ARM SPLINT, PEDIATRIC (0-10 YEARS), PLASTER                Cast sup sht arm splnt ped p52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402400100PCAST SUPPLIES, SHORT ARM SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS             Cast sup sht arm splnt ped f52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402500100PCAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), ADULT (11 YEARS +), PLASTER        Cast sup hip spica plaster  52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402600100PCAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), ADULT (11 YEARS +), FIBERGLASS     Cast sup hip spica fiberglas52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402700100PCAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), PEDIATRIC (0-10 YEARS), PLASTER    Cast sup hip spica ped plstr52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402800100PCAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), PEDIATRIC (0-10 YEARS), FIBERGLASS Cast sup hip spica ped fbrgl52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q402900100PCAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), PLASTER                       Cast sup long leg plaster   52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403000100PCAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), FIBERGLASS                    Cast sup long leg fiberglass52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403100100PCAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER                   Cast sup lng leg ped plaster52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403200100PCAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS                Cast sup lng leg ped fbrgls 52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403300100PCAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), PLASTER              Cast sup lng leg cylinder pl52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403400100PCAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), FIBERGLASS           Cast sup lng leg cylinder fb52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403500100PCAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), PLASTER          Cast sup lngleg cylndr ped p52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403600100PCAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS       Cast sup lngleg cylndr ped f52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403700100PCAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), PLASTER                      Cast sup shrt leg plaster   52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403800100PCAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), FIBERGLASS                   Cast sup shrt leg fiberglass52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q403900100PCAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER                  Cast sup shrt leg ped plster52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404000100PCAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS               Cast sup shrt leg ped fbrgls52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404100100PCAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), PLASTER                     Cast sup lng leg splnt plstr52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404200100PCAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS                  Cast sup lng leg splnt fbrgl52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404300100PCAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER                 Cast sup lng leg splnt ped p52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404400100PCAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS              Cast sup lng leg splnt ped f52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404500100PCAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), PLASTER                    Cast sup sht leg splnt plstr52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404600100PCAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS                 Cast sup sht leg splnt fbrgl52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404700100PCAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER                Cast sup sht leg splnt ped p52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404800100PCAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS             Cast sup sht leg splnt ped f52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q404900100PFINGER SPLINT, STATIC                                                           Finger splint, static       52      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q405000100PCAST SUPPLIES, FOR UNLISTED TYPES AND MATERIALS OF CASTS                        Cast supplies unlisted      57      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q405100100PSPLINT SUPPLIES, MISCELLANEOUS (INCLUDES THERMOPLASTICS, STRAPPING, FASTENERS,  Splint supplies misc        57      A                                                                                                     C                          D1A S       2001070120010701        N                           
Q405100200QPADDING AND OTHER SUPPLIES)                                                                                                                                                                                                                                                                                          
Q405200100PINJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG             Octreotide injection, depot 51      A                                                                            J2353                    C                          O1E 1P      200307012004010120031231N                           
Q405300100PINJECTION, PEGFILGRASTIM, 1 MG                                                  Pegfilgrastim, 1 mg         51      A                  2049                                                      J2505                    D                          O1E 1P      200307012004010120031231N                           
Q405400100PINJECTION, DARBEPOETIN ALFA, 1 MCG (FOR ESRD ON DIALYSIS)                       Darbepoetin alfa, esrd use  57      A                  4273.1                                                    J0882                    D                          O1E 1L      200401012006010120051231D                           
Q405500100PINJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS)                      Epoetin alfa, esrd use      57      A                  4273.1                                                    J0886                    D                          O1E 1L      200401012006010120051231D                           
Q407500100PINJECTION, ACYCLOVIR, 5 MG                                                      Acyclovir, 5 mg             51      A                                                                            J0133                    C                          O1E 1P      200310012006010120051231D                           
Q407600100PINJECTION, DOPAMINE HCL, 40 MG                                                  Dopamine hcl, 40 mg         51      A                                                                            J1265                    C                          O1E 1P      200310012006010120051231D                           
Q407700100PINJECTION, TREPROSTINIL, 1 MG                                                   Treprostinil, 1 mg          51      A                                                                            J3285                    C                          O1E 1P      200310012006010120051231D                           
Q407800100PSUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, AMMONIA N-13, PER DOSE  Ammonia N-13, per dose      53      A                  4273.1                                                    A9526                    D                          I1E 4       200310012004010120031231N                           
Q407900100PINJECTION, NATALIZUMAB, 1 MG                                                    Natalizumab injection       51      A                                                                                                     C                          O1E 1P      2005010120050101        A                           
Q408000100PILOPROST, INHALATION SOLUTION, ADMINISTERED THROUGH DME, 20 MICROGRAMS          Iloprost inhalation solution51      A                                                                                                     C                          D1G 1P      2005070120050701        A                           
Q992000100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 20 OR LESS                  Epoetin with hct <= 20      57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q992100100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 21                          Epoetin with hct = 21       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q992200100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 22                          Epoetin with hct = 22       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q992300100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 23                          Epoetin with hct = 23       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q992400100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 24                          Epoetin with hct = 24       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q992500100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 25                          Epoetin with hct = 25       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q992600100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 26                          Epoetin with hct = 26       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q992700100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 27                          Epoetin with hct = 27       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q992800100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 28                          Epoetin with hct = 28       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q992900100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 29                          Epoetin with hct = 29       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993000100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 30                          Epoetin with hct = 30       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993100100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 31                          Epoetin with hct = 31       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993200100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 32                          Epoetin with hct = 32       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993300100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 33                          Epoetin with hct = 33       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993400100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 34                          Epoetin with hct = 34       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993500100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 35                          Epoetin with hct = 35       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993600100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 36                          Epoetin with hct = 36       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993700100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 37                          Epoetin with hct = 37       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993800100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 38                          Epoetin with hct = 38       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q993900100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 39                          Epoetin with hct = 39       57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q994000100PINJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 40 OR ABOVE                 Epoetin with hct >= 40      57      A                  4273.1                                                                             D                          O1E 1L      199101012004010120031231N                           
Q994100100PINJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED, 1G                        IVIG lyophil 1G             51      A                  2049                                                                               D                          O1E 1P      200504012006010120051231D                           
Q994200100PINJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED, 10 MG                     IVIG lyophil 10 mg          51      A                  2049                                                                               D                          O1E 1P      200504012006010120051231D                           
Q994300100PINJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED, 1G                    IVIG non-lyophil 1G         51      A                  2049                                                                               D                          O1E 1P      200504012006010120051231D                           
Q994400100PINJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED, 10 MG                 IVIG non-lyophil 10 mg      51      A                  2049                                                                               D                          O1E 1P      200504012006010120051231D                           
Q994500100PLOW OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION, PER ML     LOCM <=149 mg/ml iodine, 1ml51      A                  15022                                                                              D                          I1E 4       2005040120050401        A                           
Q994600100PLOW OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML       LOCM 150-199mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005040120050401        A                           
Q994700100PLOW OSMOLAR CONTRAST MATERIAL, 200-249 MG/ML IODINE CONCENTRATION, PER ML       LOCM 200-249mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005040120050401        A                           
Q994800100PLOW OSMOLAR CONTRAST MATERIAL, 250-299 MG/ML IODINE CONCENTRATION, PER ML       LOCM 250-299mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005040120050401        A                           
Q994900100PLOW OSMOLAR CONTRAST MATERIAL, 300-349 MG/ML IODINE CONCENTRATION, PER ML       LOCM 300-349mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005040120050401        A                           
Q995000100PLOW OSMOLAR CONTRAST MATERIAL, 350-399 MG/ML IODINE CONCENTRATION, PER ML       LOCM 350-399mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005040120050401        A                           
Q995100100PLOW OSMOLAR CONTRAST MATERIAL, 400 OR GREATER MG/ML IODINE CONCENTRATION, PER MLLOCM >= 400 mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005040120050401        A                           
Q995200100PINJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, PER ML           Inj Gad-base MR contrast,1ml57      A                  15022                                                                              D                          I1F 4       2005040120050401        A                           
Q995300100PINJECTION, IRON-BASED MAGNETIC RESONANCE CONTRAST AGENT, PER ML                 Inj Fe-based MR contrast,1ml57      A                  15022                                                                              D                          I1F 4       2005040120050401        A                           
Q995400100PORAL MAGNETIC RESONANCE CONTRAST AGENT, PER 100 ML                              Oral MR contrast, 100 ml    57      A                  15022                                                                              D                          I1F 4       2005040120050401        A                           
Q995500100PINJECTION, PERFLEXANE LIPID MICROSPHERES, PER ML                                Inj perflexane lip micros,ml57      A                                                                                                     C                          I1F 4       2005040120050401        A                           
Q995600100PINJECTION, OCTAFLUOROPROPANE MICROSPHERES, PER ML                               Inj octafluoropropane mic,ml57      A                                                                                                     C                          I1F 4       2005040120050401        A                           
Q995700100PINJECTION, PERFLUTREN LIPID MICROSPHERES, PER ML                                Inj perflutren lip micros,ml57      A                                                                                                     C                          I1F 4       2005040120050401        A                           
Q995800100PHIGH OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION, PER ML    HOCM <=149 mg/ml iodine, 1ml51      A                  15022                                                                              D                          I1E 4       2005070120050701        A                           
Q995900100PHIGH OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML      HOCM 150-199mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005070120050701        A                           
Q996000100PHIGH OSMOLAR CONTRAST MATERIAL, 200-249 MG/ML IODINE CONCENTRATION, PER ML      HOCM 200-249mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005070120050701        A                           
Q996100100PHIGH OSMOLAR CONTRAST MATERIAL, 250-299 MG/ML IODINE CONCENTRATION, PER ML      HOCM 250-299mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005070120050701        A                           
Q996200100PHIGH OSMOLAR CONTRAST MATERIAL, 300-349 MG/ML IODINE CONCENTRATION, PER ML      HOCM 300-349mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005070120050701        A                           
Q996300100PHIGH OSMOLAR CONTRAST MATERIAL, 350-399 MG/ML IODINE CONCENTRATION, PER ML      HOCM 350-399mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4       2005070120050701        A                           
Q996400100PHIGH OSMOLAR CONTRAST MATERIAL, 400 OR GREATER MG/ML IODINE CONCENTRATION, PER  HOCM>= 400mg/ml iodine, 1ml 51      A                  15022                                                                              D                          I1E 4       2005070120050701        A                           
Q996400200QML                                                                                                                                                                                                                                                                                                                   
R007000100PTRANSPORTATION OF PORTABLE X-RAY EQUIPMENT AND PERSONNEL TO HOME OR NURSING     Transport portable x-ray    13      A                  2070.4  5244.B                                                                     D                          I1F 4       1982010119980101        N                           
R007000200QHOME, PER TRIP TO FACILITY OR LOCATION, ONE PATIENT SEEN                                                                                                                                                                                                                                                             
R007500100PTRANSPORTATION OF PORTABLE X-RAY EQUIPMENT AND PERSONNEL TO HOME OR NURSING     Transport port x-ray multipl13      A                  2070.4  5244.B                                                                     D                          I1F 4       1986010119980101        N                           
R007500200QHOME, PER TRIP TO FACILITY OR LOCATION, MORE THAN ONE PATIENT SEEN                                                                                                                                                                                                                                                   
R007600100PTRANSPORTATION OF PORTABLE EKG TO FACILITY OR LOCATION, PER PATIENT             Transport portable EKG      13      A50-15             2070.1  2070.4                                                                     D                      0061T2C 5       1984010119980101        N                           
S000900100PINJECTION, BUTORPHANOL TARTRATE, 1 MG                                           Injection, butorphanol tartr00      9                                                                                                     I                      0088Z2  1P      200001012004010120031231N                           
S001200100PBUTORPHANOL TARTRATE, NASAL SPRAY, 25 MG                                        Butorphanol tartrate, nasal 00      9                                                                                                     I                      0088Z2  1       2000010120000101        N                           
S001400100PTACRINE HYDROCHLORIDE, 10 MG                                                    Tacrine hydrochloride, 10 mg00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S001600100PINJECTION, AMIKACIN SULFATE, 500 MG                                             Injection, amikacin sulfate 00      9                                                                            S0072                    I                      0088Z2  1P      200001012005040120050331D                           
S001700100PINJECTION, AMINOCAPROIC ACID, 5 GRAMS                                           Injection, aminocaproic acid00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S002000100PINJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML                                     Injection, bupivicaine hydro00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S002100100PINJECTION, CEFOPERAZONE SODIUM, 1 GRAM                                          Injection, cefoperazone sod 00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S002300100PINJECTION, CIMETIDINE HYDROCHLORIDE, 300 MG                                     Injection, cimetidine hydroc00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S002800100PINJECTION, FAMOTIDINE, 20 MG                                                    Injection, famotidine, 20 mg00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S003000100PINJECTION, METRONIDAZOLE, 500 MG                                                Injection, metronidazole    00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S003200100PINJECTION, NAFCILLIN SODIUM, 2 GRAMS                                            Injection, nafcillin sodium 00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S003400100PINJECTION, OFLOXACIN, 400 MG                                                    Injection, ofloxacin, 400 mg00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S003900100PINJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML                             Injection, sulfamethoxazole 00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S004000100PINJECTION, TICARCILLIN DISODIUM AND CLAVULANATE POTASSIUM, 3.1 GRAMS            Injection, ticarcillin disod00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S007100100PINJECTION, ACYCLOVIR SODIUM, 50 MG                                              Injection, acyclovir sodium 00      9                                                                                                     I                      0088Z2  1P      200001012006010120051231D                           
S007200100PINJECTION, AMIKACIN SULFATE, 100 MG                                             Injection, amikacin sulfate 00      9                                                                                                     I                      0088Z2  1P      200001012006010120051231D                           
S007300100PINJECTION, AZTREONAM, 500 MG                                                    Injection, aztreonam, 500 mg00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S007400100PINJECTION, CEFOTETAN DISODIUM, 500 MG                                           Injection, cefotetan disodiu00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S007700100PINJECTION, CLINDAMYCIN PHOSPHATE, 300 MG                                        Injection, clindamycin phosp00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S007800100PINJECTION, FOSPHENYTOIN SODIUM, 750 MG                                          Injection, fosphenytoin sodi00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S007900100PINJECTION, OCTREOTIDE ACETATE, 100 MCG (FOR DOSES OVER 1 MG USE J2352 OR C1207) Octreotide 100 mcg          00      9                                                                                                     I                      0088Z2  1P      200201012004010120031231N                           
S008000100PINJECTION, PENTAMIDINE ISETHIONATE, 300 MG                                      Injection, pentamidine iseth00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S008100100PINJECTION, PIPERACILLIN SODIUM, 500 MG                                          Injection, piperacillin sodi00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S008500100PINJECTION, GATIFLOXACIN, 200 MG                                                 injection, gatifloxacin     00      9                                                                            J1590                    I                      0088Z2  1P      200101012003010120021231N                           
S008700100PALEMTUZUMAB INJECTION, 30 MG                                                    Alemtuzumab 30 mg           00      9                                                                            J9010                    I                      0088Z2  1P      200201012003010120021231N                           
S008800100PIMATINIB INJECTION, 100 MG                                                      Imatinib 100 mg             00      9                                                                                                     I                      0088Z2  9       2002010120030101        N                           
S009000100PSILDENAFIL CITRATE, 25 MG                                                       Sildenafil citrate, 25 mg   00      9                                                                                                     I                      0088Z2  1P      2000010120000101        N                           
S009100100PGRANISETRON HYDROCHLORIDE, 1MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE    Granisetron 1mg             00      9                                                                                                     I                      0088Z2  9       2002010120010701        N                           
S009100200QSTATUTE, USE Q0166)                                                                                                                                                                                                                                                                                                  
S009200100PINJECTION, HYDROMORPHONE HYDROCHLORIDE, 250 MG (LOADING DOSE FOR INFUSION PUMP) Hydromorphone 250 mg        00      9                                                                                                     I                      0088Z2  9       2002010120010701        N                           
S009300100PINJECTION, MORPHINE SULFATE, 500 MG (LOADING DOSE FOR INFUSION PUMP)            Morphine 500 mg             00      9                                                                                                     I                      0088Z2  9       2002010120010701        N                           
S010400100PZIDOVUDINE, ORAL, 100 MG                                                        Zidovudine, oral, 100 mg    00      9                                                                                                     I                          Z2  1       2002100120021001        N                           
S010600100PBUPROPION HCL SUSTAINED RELEASE TABLET, 150 MG, PER BOTTLE OF 60 TABLETS        Bupropion HCL SR 60 tablets 00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S010700100PINJECTION, OMALIZUMAB, 25 MG                                                    Inj, omalizumab 25 mg       00      9                                                                            J2357                    I                          Z2  9       200401012005040120050331D                           
S010800100PMERCAPTOPURINE, ORAL, 50 MG                                                     Mercaptopurine 50 mg        00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S010900100PMETHADONE, ORAL, 5 MG                                                           Methadone oral 5mg          00      9                                                                                                     I                          Z2  9       2004100120041001        N                           
S011200100PINJECTION, DARBEPOETIN ALFA, 1 MCG                                              Inj darbepoetin             00      9                                                                            J0880                    I                          Z2  1       200207012003010120021231N                           
S011400100PINJECTION, TREPROSTINIL SODIUM, 0.5 MG                                          Inj treprostinil 0.5 mg     00      9                                                                                                     I                          Z2  9       200301012006010120051231D                           
S011500100PBORTEZOMIB, 3.5 MG                                                              Bortezomib 3.5 mg           00      9                                                                                                     I                          Z2  9       200401012005010120041231N                           
S011600100PBEVACIZUMAB, 100 MG                                                             Bevacizumab 100 mg          00      9                                                                                                     I                          Z2  9       2004070120040701        N                           
S011700100PTRETINOIN, TOPICAL, 5 GRAMS                                                     Tretinoin topical 5 g       00      9                                                                                                     I                          Z2  9       2004070120040701        N                           
S011800100PINJECTION, ZICONOTIDE, FOR INTRATHECAL INFUSION, 1 MCG                          Ziconotide inthrathecal 1mcg00      9                                                                                                     I                          Z2  9       200507012006010120051231D                           
S012200100PINJECTION, MENOTROPINS, 75 IU                                                   Inj menotropins 75 iu       00      9                                                                                                     I                          Z2  1P      2002040120020401        N                           
S012400100PINJECTION, UROFOLLITROPIN, PURIFIED, 75 IU                                      Inj urofollitropin 75 iu    00      9                                                                                                     I                          Z2  1P      200204012004010120031231N                           
S012600100PINJECTION, FOLLITROPIN ALFA, 75 IU                                              Inj follitropin alfa 75 iu  00      9                                                                                                     I                          Z2  1P      2002040120020401        N                           
S012800100PINJECTION, FOLLITROPIN BETA, 75 IU                                              Inj follitropin beta 75 iu  00      9                                                                                                     I                          Z2  1P      2002040120020401        N                           
S013000100PINJECTION, CHORIONIC GONADOTROPIN, 5000 UNITS                                   Inj c gonadotropin 5000 iu  00      9                                                                                                     I                          Z2  1P      200204012004010120031231N                           
S013200100PINJECTION, GANIRELIX ACETATE, 250 MCG                                           Inj ganirelix acetat 250 mcg00      9                                                                                                     I                          Z2  1P      2002040120020401        N                           
S013300100PHISTRELIN, IMPLANT, 50 MG                                                       Histrelin implant           00      9                                                                                                     I                          Z2  9       2005070120050701        A                           
S013500100PINJECTION, PEGFILGRASTIM, 6 MG                                                  Pegfilgrastim injection 6mg 00      9                                                                                                     I                          Z2  1P      200210012004010120031231N                           
S013600100PCLOZAPINE, 25 MG                                                                Clozapine, 25 mg            00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S013700100PDIDANOSINE (DDI), 25 MG                                                         Didanosine, 25 mg           00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S013800100PFINASTERIDE, 5 MG                                                               Finasteride, 5 mg           00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S013900100PMINOXIDIL, 10 MG                                                                Minoxidil, 10 mg            00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S014000100PSAQUINAVIR, 200 MG                                                              Saquinavir, 200 mg          00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S014100100PZALCITABINE (DDC), 0.375 MG                                                     Zalcitabine, 0.375 mg       00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S014200100PCOLISTIMETHATE SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DME,            Colistimethate inh sol mg   00      9                                                                                                     I                          Z2  9       2005040120050401        A                           
S014200200QCONCENTRATED FORM, PER MG                                                                                                                                                                                                                                                                                            
S014300100PAZTREONAM, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER Aztreonam, inh sol gram     00      9                                                                                                     I                          Z2  9       2005040120050401        A                           
S014300200QGRAM                                                                                                                                                                                                                                                                                                                 
S014500100PINJECTION, PEGYLATED INTERFERON ALFA-2A, 180 MCG PER ML                         Peg interferon alfa-2A/180  00      9                                                                                                     I                          Z2  9       2005070120050701        A                           
S014600100PINJECTION, PEGYLATED INTERFERON ALFA-2B, 10 MCG PER 0.5 ML                      Peg interferon alfa-2b/10   00      9                                                                                                     I                          Z2  9       2005070120050701        A                           
S015500100PSTERILE DILUTANT FOR EPOPROSTENOL, 50ML                                         Epoprostenol dilutant       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S015600100PEXEMESTANE, 25 MG                                                               Exemestane, 25 mg           00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S015700100PBECAPLERMIN GEL 0.01%, 0.5 GM                                                   Becaplermin gel 1%, 0.5 gm  00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S015800100PINJECTION, LARONIDASE, 0.58 MG                                                  Injection laronidase        00      9                                                                            J1931                    I                          Z2  9       200404012005040120050331D                           
S015900100PINJECTION, AGALSIDASE BETA, 35 MG                                               Injection agalsidase        00      9                                                                            J0180                    I                          Z2  9       200404012005040120050331D                           
S016000100PDEXTROAMPHETAMINE SULFATE, 5 MG                                                 Dextroamphetamine           00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S016100100PCALCITROL, 0.25 MG                                                              Calcitrol                   00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S016200100PINJECTION, EFALIZUMAB, 125 MG                                                   Injection efalizumab        00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S016300100PINJECTION, RISPERIDONE, LONG ACTING, 12.5 MG                                    Injection risperidoneLA     00      9                                                                                                     I                          Z2  9       200404012005010120041231N                           
S016400100PINJECTION, PANTOPRAZOLE SODIUM, 40 MG                                           Injection pantroprazole     00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S016500100PINJECTION, ABARELIX, 100 MG                                                     Injection abarelix          00      9                                                                                                     I                          Z2  9       200404012005010120041231N                           
S016600100PINJECTION, OLANZAPINE, 2.5 MG                                                   Inj olanzapine 2.5mg        00      9                                                                                                     I                          Z2  9       2004100120041001        N                           
S016700100PINJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG                                      Inj apomorphine HCl 1mg     00      9                                                                                                     I                          Z2  9       2004100120041001        N                           
S016800100PINJECTION, AZACITIDINE, 100 MG                                                  Inj azacitidine 100mg       00      9                                                                                                     I                          Z2  9       200410012006010120051231D                           
S017000100PANASTROZOLE, ORAL, 1MG                                                          Anastrozole 1 mg            00      9                                                                                                     I                      0088Z2  1P      2002010120020101        N                           
S017100100PINJECTION, BUMETANIDE, 0.5MG                                                    Bumetanide 0.5 mg           00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S017200100PCHLORAMBUCIL, ORAL, 2MG                                                         Chlorambucil 2 mg           00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S017300100PDEXAMETHASONE, ORAL, 4MG                                                        Dexamethasone 4 mg          00      9                                                                                                     I                      0088Z2  9       200201012006010120051231D                           
S017400100PDOLASETRON MESYLATE, ORAL 50MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE    Dolasetron 50 mg            00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S017400200QSTATUTE, USE Q0180)                                                                                                                                                                                                                                                                                                  
S017500100PFLUTAMIDE, ORAL, 125MG                                                          Flutamide 125 mg            00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S017600100PHYDROXYUREA, ORAL, 500MG                                                        Hydroxyurea 500 mg          00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S017700100PLEVAMISOLE HYDROCHLORIDE, ORAL, 50MG                                            Levamisole 50 mg            00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S017800100PLOMUSTINE, ORAL, 10MG                                                           Lomustine 10 mg             00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S017900100PMEGESTROL ACETATE, ORAL, 20MG                                                   Megestrol 20 mg             00      9                                                                                                     I                      0088Z2  1P      2002010120020101        N                           
S018100100PONDANSETRON HYDROCHLORIDE, ORAL, 4MG (FOR CIRCUMSTANCES FALLING UNDER THE       Ondansetron 4 mg            00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S018100200QMEDICARE STATUTE, USE Q0179)                                                                                                                                                                                                                                                                                         
S018200100PPROCARBAZINE HYDROCHLORIDE, ORAL, 50MG                                          Procarbazine 5 mg           00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S018300100PPROCHLORPERAZINE MALEATE, ORAL, 5MG (FOR CIRCUMSTANCES FALLING UNDER THE        Prochlorperazine 5 mg       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S018300200QMEDICARE STATUTE, USE Q0164 - Q0165)                                                                                                                                                                                                                                                                                 
S018700100PTAMOXIFEN CITRATE, ORAL, 10MG                                                   Tamoxifen 10 mg             00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S018900100PTESTOSTERONE PELLET, 75MG                                                       Testosterone pellet 75 mg   00      9                                                                                                     I                      0088Z2  1P      2002010120020101        N                           
S019000100PMIFEPRISTONE, ORAL, 200 MG                                                      Mifepristone, oral, 200 mg  00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S019100100PMISOPROSTOL, ORAL, 200 MCG                                                      Misoprostol, oral, 200 mcg  00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S019300100PINJECTION, ALEFACEPT, 7.5 MG (INCLUDES DOSE PACKAGING)                          Inj alefacept 7.5 mg        00      9                                                                                                     I                          Z2  9       200310012004010120031231N                           
S019400100PDIALYSIS/STRESS VITAMIN SUPPLEMENT, ORAL, 100 CAPSULES                          Vitamin suppl 100 caps      00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S019500100PPNEUMOCOCCAL CONJUGATE VACCINE, POLYVALENT, INTRAMUSCULAR, FOR CHILDREN FROM    Pneumo vaccine 5-9 yrs      00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S019500200QFIVE YEARS TO NINE YEARS OF AGE WHO HAVE NOT PREVIOUSLY RECEIVED THE VACCINE                                                                                                                                                                                                                                         
S019600100PINJECTABLE POLY-L-LACTIC ACID, RESTORATIVE IMPLANT, 1 ML, FACE (DEEP DERMIS,    Poly-l-lactic acid 1ml face 00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
S019600200QSUBCUTANEOUS LAYERS)                                                                                                                                                                                                                                                                                                 
S019700100PPRENATAL VITAMINS, 30-DAY SUPPLY                                                Prenatal vitamins 30 day    00      9                                                                                                     I                          Z2  9       2005040120050401        A                           
S019800100PINJECTION, PEGAPTANIB SODIUM, 0.3 MG                                            Inj pegaptanib 0.3 mg       00      9                                                                                                     I                          Z2  9       2005070120050701        A                           
S019900100PMEDICALLY INDUCED ABORTION BY ORAL INGESTION OF MEDICATION INCLUDING ALL        Med abortion inc all ex drug00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S019900200QASSOCIATED SERVICES AND SUPPLIES (E.G., PATIENT COUNSELING, OFFICE VISITS,                                                                                                                                                                                                                                           
S019900300QCONFIRMATION OF PREGNANCY BY HCG, ULTRASOUND TO CONFIRM DURATION OF PREGNANCY,                                                                                                                                                                                                                                       
S019900400QULTRASOUND TO CONFIRM COMPLETION OF ABORTION) EXCEPT DRUGS                                                                                                                                                                                                                                                           
S020100100PPARTIAL HOSPITALIZATION SERVICES, LESS THAN 24 HOURS, PER DIEM                  Partial hospitalization serv00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S020600100PPROCEDURE PERFORMED IN SURGERY SUITE IN PHYSICIAN'S OFFICE (LIST SEPARATELY IN  Surgery in office           00      9                                                                            MODSU                    I                      0088Z2  2       200107012003010120021231N                           
S020600200QADDITION TO CODE FOR PRIMARY PROCEDURE TO DENOTE USE OF FACILITY AND EQUIPMENT)                                                                                                                                                                                                                                      
S020700100PPARAMEDIC INTERCEPT, NON-HOSPITAL-BASED ALS SERVICE (NON-VOLUNTARY),            Paramedicintercep nonhospals00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S020700200QNON-TRANSPORT                                                                                                                                                                                                                                                                                                        
S020800100PPARAMEDIC INTERCEPT, HOSPITAL-BASED ALS SERVICE (NON-VOLUNTARY), NON-TRANSPORT  Paramed intrcept nonvol     00      9                                                                                                     I                      0088Z2  D       2002010120020101        N                           
S020900100PWHEELCHAIR VAN, MILEAGE, PER MILE                                               WC van mileage per mi       00      9                                                                                                     I                      0088Z2  D       2002010120020101        N                           
S021500100PNON-EMERGENCY TRANSPORTATION; MILEAGE, PER MILE                                 Nonemerg transp mileage     00      9                                                                                                     I                      0088Z2  D       2002010120020401        N                           
S022000100PMEDICAL CONFERENCE BY A PHYSICIAN WITH INTERDISCIPLINARY TEAM OF HEALTH         Medical conference by physic00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S022000200QPROFESSIONALS OR REPRESENTATIVES OF COMMUNITY AGENCIES TO COORDINATE ACTIVITIES                                                                                                                                                                                                                                      
S022000300QOF PATIENT CARE (PATIENT IS PRESENT); APPROXIMATELY 30 MINUTES                                                                                                                                                                                                                                                       
S022100100PMEDICAL CONFERENCE BY A PHYSICIAN WITH INTERDISCIPLINARY TEAM OF HEALTH         Medical conference, 60 min  00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S022100200QPROFESSIONALS OR REPRESENTATIVES OF COMMUNITY AGENCIES TO COORDINATE ACTIVITIES                                                                                                                                                                                                                                      
S022100300QOF PATIENT CARE (PATIENT IS PRESENT); APPROXIMATELY 60 MINUTES                                                                                                                                                                                                                                                       
S025000100PCOMPREHENSIVE GERIATRIC ASSESSMENT AND TREATMENT PLANNING PERFORMED BY          Comp geriatr assmt team     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S025000200QASSESSMENT TEAM                                                                                                                                                                                                                                                                                                      
S025500100PHOSPICE REFERRAL VISIT (ADVISING PATIENT AND FAMILY OF CARE OPTIONS) PERFORMED  Hospice refer visit nonmd   00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S025500200QBY NURSE, SOCIAL WORKER, OR OTHER DESIGNATED STAFF                                                                                                                                                                                                                                                                   
S025700100PCOUNSELING AND DISCUSSION REGARDING ADVANCE DIRECTIVES OR END OF LIFE CARE      End of life counseling      00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
S025700200QPLANNING AND DECISIONS, WITH PATIENT AND/OR SURROGATE (LIST SEPARATELY IN                                                                                                                                                                                                                                            
S025700300QADDITION TO CODE FOR APPROPRIATE EVALUATION AND MANAGEMENT SERVICE)                                                                                                                                                                                                                                                  
S026000100PHISTORY AND PHYSICAL (OUTPATIENT OR OFFICE) RELATED TO SURGICAL PROCEDURE (LIST H&P for surgery             00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S026000200QSEPARATELY IN ADDITION TO CODE FOR APPROPRIATE EVALUATION AND MANAGEMENT                                                                                                                                                                                                                                             
S026000300QSERVICE)                                                                                                                                                                                                                                                                                                             
S026500100PGENETIC COUNSELING, UNDER PHYSICIAN SUPERVISION, EACH 15 MINUTES                Genetic counsel 15 mins     00      9                                                                                                     I                          Z2  9       2005070120050701        A                           
S030200100PCOMPLETED EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) SERVICE      Completed EPSDT             00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S030200200Q(LIST IN ADDITION TO CODE FOR APPROPRIATE EVALUATION AND MANAGEMENT SERVICE)                                                                                                                                                                                                                                         
S031000100PHOSPITALIST SERVICES (LIST SEPARATELY IN ADDITION TO CODE FOR APPROPRIATE       Hospitalist visit           00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S031000200QEVALUATION AND MANAGEMENT SERVICE)                                                                                                                                                                                                                                                                                   
S031500100PDISEASE MANAGEMENT PROGRAM; INITIAL ASSESSMENT AND INITIATION OF THE PROGRAM    Disease management program  00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S031600100PFOLLOW-UP/REASSESSMENT                                                          Follow-up/reassessment      00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S031700100PDISEASE MANAGEMENT PROGRAM; PER DIEM                                            Disease mgmt per diem       00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S032000100PTELEPHONE CALLS BY A REGISTERED NURSE TO A DISEASE MANAGEMENT PROGRAM MEMBER    RN telephone calls to DMP   00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S032000200QFOR MONITORING PURPOSES; PER MONTH                                                                                                                                                                                                                                                                                   
S034000100PLIFESTYLE MODIFICATION PROGRAM FOR MANAGEMENT OF CORONARY ARTERY DISEASE,       Lifestyle mod 1st stage     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S034000200QINCLUDING ALL SUPPORTIVE SERVICES; FIRST QUARTER / STAGE                                                                                                                                                                                                                                                             
S034100100PLIFESTYLE MODIFICATION PROGRAM FOR MANAGEMENT OF CORONARY ARTERY DISEASE,       Lifestyle mod 2 or 3 stage  00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S034100200QINCLUDING ALL SUPPORTIVE SERVICES; SECOND OR THIRD QUARTER / STAGE                                                                                                                                                                                                                                                   
S034200100PLIFESTYLE MODIFICATION PROGRAM FOR MANAGEMENT OF CORONARY ARTERY DISEASE,       Lifestyle mod 4th stage     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S034200200QINCLUDING ALL SUPPORTIVE SERVICES; FOURTH QUARTER / STAGE                                                                                                                                                                                                                                                            
S039000100PROUTINE FOOT CARE; REMOVAL AND/OR TRIMMING OF CORNS, CALLUSES AND/OR NAILS AND  Rout foot care per visit    00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S039000200QPREVENTIVE MAINTENANCE IN SPECIFIC MEDICAL CONDITIONS (E.G. DIABETES), PER VISIT                                                                                                                                                                                                                                     
S039500100PIMPRESSION CASTING OF A FOOT PERFORMED BY A PRACTITIONER OTHER THAN THE         Impression casting ft       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S039500200QMANUFACTURER OF THE ORTHOTIC                                                                                                                                                                                                                                                                                         
S040000100PGLOBAL FEE FOR EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY TREATMENT OF KIDNEY        Global eswl kidney          00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S040000200QSTONE(S)                                                                                                                                                                                                                                                                                                             
S050000100PDISPOSABLE CONTACT LENS, PER LENS                                               Dispos cont lens            00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S050400100PSINGLE VISION PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS       Singl prscrp lens           00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S050600100PBIFOCAL VISION PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS      Bifoc prscp lens            00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S050800100PTRIFOCAL VISION PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS     Trifoc prscrp lens          00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S051000100PNON-PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS),  PER LENS                Non-prscrp lens             00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S051200100PDAILY WEAR SPECIALTY CONTACT LENS, PER LENS                                     Daily cont lens             00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S051400100PCOLOR CONTACT LENS, PER LENS                                                    Color cont lens             00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S051500100PSCLERAL LENS, LIQUID BANDAGE DEVICE, PER LENS                                   Scleral lens liquid bandage 00      9                                                                                                     I                          Z2  9       2004100120041001        N                           
S051600100PSAFETY EYEGLASS FRAMES                                                          Safety frames               00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S051800100PSUNGLASSES FRAMES                                                               Sunglass frames             00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S058000100PPOLYCARBONATE LENS (LIST THIS CODE IN ADDITION TO THE BASIC CODE FOR THE LENS)  Polycarb lens               00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S058100100PNONSTANDARD LENS (LIST THIS CODE IN ADDITION TO THE BASIC CODE FOR THE LENS)    Nonstnd lens                00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S059000100PINTEGRAL LENS SERVICE, MISCELLANEOUS SERVICES REPORTED SEPARATELY               Misc integral lens serv     00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S059200100PCOMPREHENSIVE CONTACT LENS EVALUATION                                           Comp cont lens eval         00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S059500100PDISPENSING NEW SPECTACLE LENSES FOR PATIENT SUPPLIED FRAME                      New lenses in pts old frame 00      9                                                                                                     I                          Z2  9       2005040120050401        A                           
S060100100PSCREENING PROCTOSCOPY                                                           Screening proctoscopy       00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S060500100PDIGITAL RECTAL EXAMINATION, ANNUAL                                              Digital rectal examination, 00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S061000100PANNUAL GYNECOLOGICAL EXAMINATION, NEW PATIENT                                   Annual gynecological examina00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S061200100PANNUAL GYNECOLOGICAL EXAMINATION, ESTABLISHED PATIENT                           Annual gynecological examina00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S061300100PANNUAL GYNECOLOGICAL EXAMINATION; CLINICAL BREAST EXAMINATION WITHOUT PELVIC    Ann breast exam             00      9                                                                                                     I                          Z2  9       2005070120050701        A                           
S061300200QEVALUATION                                                                                                                                                                                                                                                                                                           
S061800100PAUDIOMETRY FOR HEARING AID EVALUATION TO DETERMINE THE LEVEL AND DEGREE OF      Audiometry for hearing aid  00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S061800200QHEARING LOSS                                                                                                                                                                                                                                                                                                         
S062000100PROUTINE OPHTHALMOLOGICAL EXAMINATION INCLUDING REFRACTION; NEW PATIENT          Routine ophthalmological exa00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S062100100PROUTINE OPHTHALMOLOGICAL EXAMINATION INCLUDING REFRACTION; ESTABLISHED PATIENT  Routine ophthalmological exa00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S062200100PPHYSICAL EXAM FOR COLLEGE, NEW OR ESTABLISHED PATIENT (LIST SEPARATELY IN       Phys exam for college       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S062200200QADDITION TO APPROPRIATE EVALUATION AND MANAGEMENT CODE)                                                                                                                                                                                                                                                              
S062500100PRETINAL TELESCREENING BY DIGITAL IMAGING OF MULTIPLE DIFFERENT FUND US AREAS TO Digital screening retina    00      9                                                                                                     I                          Z2  9       2005040120050401        A                           
S062500200QSCREEN FOR VISION-THREATENING CONDITIONS, INCLUDING IMAGING, INTERPRETATION AND                                                                                                                                                                                                                                      
S062500300QREPORT                                                                                                                                                                                                                                                                                                               
S063000100PREMOVAL OF SUTURES; BY A PHYSICIAN OTHER THAN THE PHYSICIAN WHO ORIGINALLY      Removal of sutures          00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S063000200QCLOSED THE WOUND                                                                                                                                                                                                                                                                                                     
S080000100PLASER IN SITU KERATOMILEUSIS (LASIK)                                            Laser in situ keratomileusis00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S081000100PPHOTOREFRACTIVE KERATECTOMY (PRK)                                               Photorefractive keratectomy 00      9                                                                                                     I                      0088Z2  29      2000010120000101        N                           
S081200100PPHOTOTHERAPEUTIC KERATECTOMY (PTK)                                              Phototherap keratect        00      9                                                                                                     I                      0088Z2  Q       2001070120010701        N                           
S082000100PCOMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL                                     Computerized corneal topogra00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S083000100PULTRASOUND PACHYMETRY TO DETERMINE CORNEAL THICKNESS, WITH INTERPRETATION AND   Ultrasound pachymetry       00      9                                                                                                     I                      0088Z2  9       200101012004040120040331N                           
S083000200QREPORT, UNILATERAL                                                                                                                                                                                                                                                                                                   
S100100100PDELUXE ITEM, PATIENT AWARE (LIST IN ADDITION TO CODE FOR BASIC ITEM)            Deluxe item                 00      9                                                                                                     I                      0088Z2  P       2001070120010701        N                           
S100200100PCUSTOMIZED ITEM (LIST IN ADDITION TO CODE FOR BASIC ITEM)                       Custom item                 00      9                                                                                                     I                      0088Z2  P       2001070120010701        N                           
S101500100PIV TUBING EXTENSION SET                                                         IV tubing extension set     00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S101600100PNON-PVC (POLYVINYL CHLORIDE) INTRAVENOUS ADMINISTRATION SET, FOR USE WITH DRUGS Non-pvc intravenous administ00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S101600200QTHAT ARE NOT STABLE IN PVC E.G. PACLITAXEL                                                                                                                                                                                                                                                                           
S102500100PINHALED NITRIC OXIDE FOR THE TREATMENT OF HYPOXIC RESPIRATORY FAILURE IN THE    Inhal nitric oxide neonate  00      9                                                                                                     I                      0088Z2  1       2002010120020101        N                           
S102500200QNEONATE; PER DIEM                                                                                                                                                                                                                                                                                                    
S103000100PCONTINUOUS NONINVASIVE GLUCOSE MONITORING DEVICE, PURCHASE (FOR PHYSICIAN       Gluc monitor purchase       00      9                                                                                                     I                      0088Z2  PR      2002010120020101        N                           
S103000200QINTERPRETATION OF DATA, USE CPT CODE)                                                                                                                                                                                                                                                                                
S103100100PCONTINUOUS NONINVASIVE GLUCOSE MONITORING DEVICE, RENTAL, INCLUDING SENSOR,     Gluc monitor rental         00      9                                                                                                     I                      0088Z2  APR     2002010120020101        N                           
S103100200QSENSOR REPLACEMENT, AND DOWNLOAD TO MONITOR (FOR PHYSICIAN INTERPRETATION OF                                                                                                                                                                                                                                         
S103100300QDATA, USE CPT CODE)                                                                                                                                                                                                                                                                                                  
S104000100PCRANIAL REMOLDING ORTHOSIS, RIGID, WITH SOFT INTERFACE MATERIAL, CUSTOM         Cranial remolding orthosis  00      9                                                                                                     I                          Z2  P       2002100120021001        N                           
S104000200QFABRICATED, INCLUDES FITTING AND ADJUSTMENT(S)                                                                                                                                                                                                                                                                       
S205300100PTRANSPLANTATION OF SMALL INTESTINE AND LIVER ALLOGRAFTS                         Transplantation of small int00      9                                                                                                     I                      0088Z2  29      2000010120000101        N                           
S205400100PTRANSPLANTATION OF MULTIVISCERAL ORGANS                                         Transplantation of multivisc00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S205500100PHARVESTING OF DONOR MULTIVISCERAL ORGANS, WITH PREPARATION AND MAINTENANCE OF   Harvesting of donor multivis00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S205500200QALLOGRAFTS; FROM CADAVER DONOR                                                                                                                                                                                                                                                                                       
S206000100PLOBAR LUNG TRANSPLANTATION                                                      Lobar lung transplantation  00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S206100100PDONOR LOBECTOMY (LUNG) FOR TRANSPLANTATION, LIVING DONOR                        Donor lobectomy (lung)      00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S206500100PSIMULTANEOUS PANCREAS KIDNEY TRANSPLANTATION                                    Simult panc kidn trans      00      9                                                                                                     I                      0088Z2  2       2001070120010701        N                           
S206800100PBREAST RECONSTRUCTION WITH DEEP INFERIOR EPIGASTRIC PERFORATOR (DIEP) FLAP,     Breast DIEP flap reconstruct00      9                                                                                                     I                          Z2  9       2006010120060101        A                           
S206800200QINCLUDING MICROVASCULAR ANASTOMOSIS AND CLOSURE OF DONOR SITE, UNILATERAL                                                                                                                                                                                                                                            
S207000100PCYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH ENDOSCOPIC LASER   Cysto laser tx ureteral calc00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S207000200QTREATMENT OF URETERAL CALCULI (INCLUDES URETERAL CATHETERIZATION)                                                                                                                                                                                                                                                    
S207500100PLAPAROSCOPY, SURGICAL; REPAIR INCISIONAL OR VENTRAL HERNIA                      Lap inc/vent hernia repair  00      9                                                                                                     I                          Z2  9       2005100120051001        A                           
S207600100PLAPAROSCOPY, SURGICAL; REPAIR UMBILICAL HERNIA                                  Lap umbilical hernia repair 00      9                                                                                                     I                          Z2  9       2005100120051001        A                           
S207700100PLAPAROSCOPY, SURGICAL; IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR INCISIONAL  Lap mesh implant hern rep   00      9                                                                                                     I                          Z2  9       2005100120051001        A                           
S207700200QOR VENTRAL HERNIA REPAIR (LIST SEPARATELY IN ADDITION TO CODE FOR INCISIONAL OR                                                                                                                                                                                                                                      
S207700300QVENTRAL HERNIA REPAIR)                                                                                                                                                                                                                                                                                               
S207800100PLAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY (SUBTOTAL HYSTERECTOMY), WITH OR        Lap supracerv hysterectomy  00      9                                                                                                     I                          Z2  9       2006010120060101        A                           
S207800200QWITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S)                                                                                                                                                                                                                                                      
S207900100PLAPAROSCOPIC ESOPHAGOMYOTOMY (HELLER TYPE)                                      Lap esophagomyotomy         00      9                                                                                                     I                          Z2  9       2006010120060101        A                           
S208000100PLASER-ASSISTED UVULOPALATOPLASTY (LAUP)                                         Laup                        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S208200100PLAPAROSCOPY, SURGICAL; GASTRIC RESTRICTIVE PROCEDURE, ADJUSTABLE GASTRIC BAND   Lap adjustable gastric band 00      9                                                                                                     I                          Z2  9       200404012006010120051231D                           
S208200200Q(INCLUDES PLACEMENT OF SUBCUTANEOUS PORT)                                                                                                                                                                                                                                                                            
S208300100PADJUSTMENT OF GASTRIC BAND DIAMETER VIA SUBCUTANEOUS PORT BY INJECTION OR       Adjustment gastric band     00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S208300200QASPIRATION OF SALINE                                                                                                                                                                                                                                                                                                 
S208500100PLAPAROSCOPY, GASTRIC RESTRICTIVE PROCEDURE, WITH GASTRIC BYPASS FOR MORBID      Laparoscop gastric bypass   00      9                                                                                                     I                          Z2  9       200401012005010120041231N                           
S208500200QOBESITY, WITH SHORT LIMB (LESS THAN 100 CM) ROUX-EN-Y GASTROENTEROSTOMY                                                                                                                                                                                                                                              
S209000100PABLATION, OPEN, ONE OR MORE RENAL TUMOR(S); CRYOSURGICAL                        Open cryosurg renal         00      9                                                                                                     I                          Z2  9       200304012006010120051231D                           
S209100100PABLATION, PERCUTANEOUS, ONE OR MORE RENAL TUMOR(S); CRYOSURGICAL                Perc cryosurg renal         00      9                                                                                                     I                          Z2  9       200304012006010120051231D                           
S209500100PTRANSCATHETER OCCLUSION OR EMBOLIZATION FOR TUMOR DESTRUCTION, PERCUTANEOUS,    Transcath emboliz microspher00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
S209500200QANY METHOD, USING YTTRIUM-90 MICROSPHERES                                                                                                                                                                                                                                                                            
S210200100PISLET CELL TISSUE TRANSPLANT FROM PANCREAS; ALLOGENEIC                          Islet cell tissue transplant00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S210300100PADRENAL TISSUE TRANSPLANT TO BRAIN                                              Adrenal tissue transplant   00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S210700100PADOPTIVE IMMUNOTHERAPY I.E. DEVELOPMENT OF SPECIFIC ANTI-TUMOR REACTIVITY (E.G. Adoptive immunotherapy      00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S210700200QTUMOR-INFILTRATING LYMPHOCYTE THERAPY) PER COURSE OF TREATMENT                                                                                                                                                                                                                                                       
S211200100PARTHROSCOPY, KNEE, SURGICAL FOR HARVESTING OF CARTILAGE (CHONDROCYTE CELLS)     Knee arthroscp harv         00      9                                                                                                     I                      0088Z2  2       2001070120010701        N                           
S211300100PARTHROSCOPY, KNEE, SURGICAL FOR IMPLANTATION OF CULTURED ANALOGOUS CHONDROCYTES Arthro chondrocyte implant  00      9                                                                                                     I                          Z2  9       200401012005010120041231N                           
S211400100PARTHROSCOPY, SHOULDER, SURGICAL; TENODESIS OF BICEPS                            Arthrosc sh tenodesis biceps00      9                                                                                                     I                          Z2  9       2005100120051001        A                           
S211500100POSTEOTOMY, PERIACETABULAR, WITH INTERNAL FIXATION                               Periacetabular osteotomy    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S211700100PARTHROEREISIS, SUBTALAR                                                         Arthroereisis, subtalar     00      9                                                                                                     I                          Z2  9       2005100120051001        A                           
S212000100PLOW DENSITY LIPOPROTEIN (LDL) APHERESIS USING HEPARIN-INDUCED EXTRACORPOREAL    Low density lipoprotein(LDL)00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S212000200QLDL PRECIPITATION                                                                                                                                                                                                                                                                                                    
S213000100PENDOLUMINAL RADIOFREQUENCY ABLATION OF REFLUXING SAPHENOUS VEINS                Endo RF ablation saph vein  00      9                                                                                                     I                          Z2  9       200301012005010120041231N                           
S213100100PENDOVASCULAR LASER ABLATION OF LONG OR SHORT SAPHENOUS VEIN, WITH OR WITHOUT    Laser ablat saphenous vein  00      9                                                                                                     I                          Z2  9       200404012005010120041231N                           
S213100200QPROXIMAL LIGATION OR DIVISION                                                                                                                                                                                                                                                                                        
S213500100PNEUROLYSIS, BY INJECTION, OF METATARSAL NEUROMA/INTERDIGITAL NEURITIS, ANY      Neurolysis interspace foot  00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
S213500200QINTERSPACE OF THE FOOT                                                                                                                                                                                                                                                                                               
S214000100PCORD BLOOD HARVESTING FOR TRANSPLANTATION, ALLOGENEIC                           Cord blood harvesting       00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S214200100PCORD BLOOD-DERIVED STEM-CELL TRANSPLANTATION, ALLOGENEIC                        Cord blood-derived stem-cell00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S215000100PBONE MARROW OR BLOOD-DERIVED STEM CELLS (PERIPHERAL OR UMBILICAL), ALLOGENEIC   BMT harv/transpl 28d pkg    00      9                                                                                                     I                      0088Z2  9       2002010120040401        N                           
S215000200QOR AUTOLOGOUS, HARVESTING, TRANSPLANTATION, AND RELATED COMPLICATIONS;                                                                                                                                                                                                                                               
S215000300QINCLUDING: PHERESIS AND CELL PREPARATION/STORAGE; MARROW ABLATIVE THERAPY;                                                                                                                                                                                                                                           
S215000400QDRUGS, SUPPLIES, HOSPITALIZATION WITH OUTPATIENT FOLLOW-UP; MEDICAL/SURGICAL,                                                                                                                                                                                                                                        
S215000500QDIAGNOSTIC, EMERGENCY, AND REHABILITATIVE SERVICES; AND THE NUMBER OF DAYS OF                                                                                                                                                                                                                                        
S215000600QPRE-AND POST-TRANSPLANT CARE IN THE GLOBAL DEFINITION                                                                                                                                                                                                                                                                
S215200100PSOLID ORGAN(S), COMPLETE OR SEGMENTAL, SINGLE ORGAN OR COMBINATION OF ORGANS;   Solid organ transpl pkg     00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S215200200QDECEASED OR LIVING DONOR (S), PROCUREMENT, TRANSPLANTATION, AND RELATED                                                                                                                                                                                                                                              
S215200300QCOMPLICATIONS; INCLUDING: DRUGS; SUPPLIES; HOSPITALIZATION WITH OUTPATIENT                                                                                                                                                                                                                                           
S215200400QFOLLOW-UP; MEDICAL/SURGICAL, DIAGNOSTIC, EMERGENCY, AND REHABILITATIVE                                                                                                                                                                                                                                               
S215200500QSERVICES, AND THE NUMBER OF DAYS OF PRE- AND POST-TRANSPLANT CARE IN THE GLOBAL                                                                                                                                                                                                                                      
S215200600QDEFINITION                                                                                                                                                                                                                                                                                                           
S218000100PDONOR LEUKOCYTE INFUSION (E.G. DLI, DONOR LYMPHOCYTE INFUSION, DONOR BUFFY COAT Donor leukocyte infusion    00      9                                                                            38242                    I                      0088Z2  9       200101012003010120021231N                           
S218000200QCELL TRANSFUSION, DONOR PERIPHERAL BLOOD MONOCYTE TRANSFUSION)                                                                                                                                                                                                                                                       
S220200100PECHOSCLEROTHERAPY                                                               Echosclerotherapy           00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S220500100PMINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S220500200QMINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S220500300QUSING ARTERIAL GRAFT(S), SINGLE CORONARY ARTERIAL GRAFT                                                                                                                                                                                                                                                              
S220600100PMINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S220600200QMINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S220600300QUSING ARTERIAL GRAFT(S), TWO CORONARY ARTERIAL GRAFTS                                                                                                                                                                                                                                                                
S220700100PMINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S220700200QMINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S220700300QUSING VENOUS GRAFT ONLY, SINGLE CORONARY VENOUS GRAFT                                                                                                                                                                                                                                                                
S220800100PMINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S220800200QMINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S220800300QUSING SINGLE ARTERIAL AND VENOUS GRAFT(S), SINGLE VENOUS GRAFT                                                                                                                                                                                                                                                       
S220900100PMINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S220900200QMINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S220900300QUSING TWO ARTERIAL GRAFTS AND SINGLE VENOUS GRAFT                                                                                                                                                                                                                                                                    
S221100100PTRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), CAROTID ARTERY,              Transv carotid stent placemt00      9                                                                                                     I                          Z2  9       200204012005010120041231N                           
S221100200QPERCUTANEOUS, UNILATERAL (IF PERFORMED BILATERALLY, USE-50 MODIFIER)                                                                                                                                                                                                                                                 
S221300100PIMPLANTATION OF GASTRIC ELECTRICAL STIMULATION DEVICE                           Implant gastric stim        00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S221500100PUPPER GASTROINTESTINAL ENDOSCOPY, INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE  UGI endoscopy inj implant   00      9                                                                                                     I                          Z2  9       200410012006010120051231D                           
S221500200QDUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH INJECTION OF IMPLANT MATERIAL INTO                                                                                                                                                                                                                                      
S221500300QAND ALONG THE MUSCLE OF THE LOWER ESOPHAGEAL SPHINCTER FOR TREATMENT OF                                                                                                                                                                                                                                              
S221500400QGASTROESOPHAGEAL REFLUX DISEASE                                                                                                                                                                                                                                                                                      
S222500100PMYRINGOTOMY, LASER-ASSISTED                                                     Myringotomy laser-assist    00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
S223000100PIMPLANTATION OF MAGNETIC COMPONENT OF SEMI-IMPLANTABLE HEARING DEVICE ON        Implant semi-imp hear       00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S223000200QOSSICLES IN MIDDLE EAR                                                                                                                                                                                                                                                                                               
S223500100PIMPLANTATION OF AUDITORY BRAIN STEM IMPLANT                                     Implant auditory brain imp  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S225000100PUTERINE ARTERY EMBOLIZATION FOR UTERINE FIBROIDS                                Uterine artery emboliz      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S225500100PHYSTEROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BILATERALLY BY MICRO-INSERTS Hysterosc oviduct occlus    00      9                                                                                                     I                          Z2  9       200404012005010120041231N                           
S225500200QFOR PERMANENT STERILIZATION                                                                                                                                                                                                                                                                                          
S226000100PINDUCED ABORTION, 17 TO 24 WEEKS, ANY SURGICAL METHOD                           Induced abortion 17-24 weeks00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S226200100PABORTION FOR MATERNAL INDICATION, 25 WEEKS OR GREATER                           Abortion maternal indic>=25w00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S226500100PABORTION FOR FETAL INDICATION, 25-28 WEEKS                                      Abortion 25-28wks fetal indi00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S226600100PABORTION FOR FETAL INDICATION, 29-31 WEEKS                                      Abortion 29-31wks fetal indi00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S226700100PABORTION FOR FETAL INDICATION, 32 WEEKS OR GREATER                              Abortion >=32wks fetal indic00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S230000100PARTHROSCOPY, SHOULDER, SURGICAL; WITH THERMALLY-INDUCED CAPSULORRHAPHY          Arthroscopy, shoulder, surgi00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S234000100PCHEMODENERVATION OF ABDUCTOR MUSCLE(S) OF VOCAL CORD                            Chemodenervation of abductor00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S234100100PCHEMODENERVATION OF ADDUCTOR MUSCLE(S) OF VOCAL CORD                            Chemodenerv adduct vocal    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S234200100PNASAL ENDOSCOPY FOR POST-OPERATIVE DEBRIDEMENT FOLLOWING FUNCTIONAL ENDOSCOPIC  Nasal endoscop po debrid    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S234200200QSINUS SURGERY, NASAL AND/OR SINUS CAVITY(S), UNILATERAL OR BILATERAL                                                                                                                                                                                                                                                 
S234800100PDECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL    Decompress disc RF lumbar   00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
S234800200QDISC, USING RADIOFREQUENCY ENERGY, SINGLE OR MULTIPLE LEVELS, LUMBAR                                                                                                                                                                                                                                                 
S235000100PDISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S),   Diskectomy, anterior, with d00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S235000200QINCLUDING OSTEOPHYTECTOMY; LUMBAR, SINGLE INTERSPACE                                                                                                                                                                                                                                                                 
S235100100PDISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S),   Diskectomy, anterior, with d00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S235100200QINCLUDING OSTEOPHYTECTOMY; LUMBAR, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY                                                                                                                                                                                                                                       
S235100300QIN ADDITION TO CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                           
S236000100PPERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL        Vertebroplast cerv 1st      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S236000200QINJECTION; CERVICAL                                                                                                                                                                                                                                                                                                  
S236100100PEACH ADDITIONAL CERVICAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE    Vertebroplast cerv addl     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S236100200QFOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                               
S236200100PKYPHOPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION              Kyphoplasty, first vertebra 00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
S236300100PKYPHOPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; EACH        Kyphoplasty, each addl      00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
S236300200QADDITIONAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY                                                                                                                                                                                                                                           
S236300300QPROCEDURE)                                                                                                                                                                                                                                                                                                           
S237000100PINTRADISCAL ELECTROTHERMAL THERAPY; SINGLE INTERSPACE                           Intradiscal electrothermal  00      9                                                                                                     I                      0088Z2  9       200101012004100120040930N                           
S237100100PEACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY     Each additional interspace  00      9                                                                                                     I                      0088Z2  9       200101012004100120040930N                           
S237100200QPROCEDURE)                                                                                                                                                                                                                                                                                                           
S240000100PREPAIR, CONGENITAL DIAPHRAGMATIC HERNIA IN THE FETUS USING TEMPORARY TRACHEAL   Fetal surg congen hernia    00      9                                                                                                     I                      0088Z2  2       2002010120020401        N                           
S240000200QOCCLUSION, PROCEDURE PERFORMED IN UTERO                                                                                                                                                                                                                                                                              
S240100100PREPAIR, URINARY TRACT OBSTRUCTION IN THE FETUS, PROCEDURE PERFORMED IN UTERO    Fetal surg urin trac obstr  00      9                                                                                                     I                      0088Z2  2       2002010120020101        N                           
S240200100PREPAIR, CONGENITAL CYSTIC ADENOMATOID MALFORMATION IN THE FETUS, PROCEDURE      Fetal surg cong cyst malf   00      9                                                                                                     I                      0088Z2  2       2002010120020101        N                           
S240200200QPERFORMED IN UTERO                                                                                                                                                                                                                                                                                                   
S240300100PREPAIR, EXTRALOBAR PULMONARY SEQUESTRATION IN THE FETUS, PROCEDURE PERFORMED IN Fetal surg pulmon sequest   00      9                                                                                                     I                      0088Z2  2       2002010120020101        N                           
S240300200QUTERO                                                                                                                                                                                                                                                                                                                
S240400100PREPAIR, MYELOMENINGOCELE IN THE FETUS, PROCEDURE PERFORMED IN UTERO             Fetal surg myelomeningo     00      9                                                                                                     I                      0088Z2  2       2002010120020101        N                           
S240500100PREPAIR OF SACROCOCCYGEAL TERATOMA IN THE FETUS, PROCEDURE PERFORMED IN UTERO    Fetal surg sacrococ teratoma00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S240900100PREPAIR, CONGENITAL MALFORMATION OF FETUS, PROCEDURE PERFORMED IN UTERO, NOT     Fetal surg noc              00      9                                                                                                     I                      0088Z2  2       2002010120020101        N                           
S240900200QOTHERWISE CLASSIFIED                                                                                                                                                                                                                                                                                                 
S241100100PFETOSCOPIC LASER THERAPY FOR TREATMENT OF TWIN-TO-TWIN TRANSFUSION SYNDROME     Fetoscop laser ther TTTS    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S290000100PSURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY   Robotic surgical system     00      9                                                                                                     I                          Z2  9       2005070120050701        A                           
S290000200QIN ADDITION TO CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                           
S300000100PDIABETIC INDICATOR; RETINAL EYE EXAM, DILATED, BILATERAL                        Bilat dil retinal exam      00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S300500100PPERFORMANCE MEASUREMENT, EVALUATION OF PATIENT SELF ASSESSMENT, DEPRESSION      Eval self-assess depression 00      9                                                                                                     I                          Z2  9       2005040120050401        A                           
S360000100PSTAT LABORATORY REQUEST (SITUATIONS OTHER THAN S3601)                           Stat lab                    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S360100100PEMERGENCY STAT LABORATORY CHARGE FOR PATIENT WHO IS HOMEBOUND OR RESIDING  IN A Stat lab home/nf            00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S360100200QNURSING FACILITY                                                                                                                                                                                                                                                                                                     
S362000100PNEWBORN METABOLIC SCREENING PANEL, INCLUDES TEST KIT, POSTAGE AND THE           Newborn metabolic screening 00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S362000200QLABORATORY TESTS SPECIFIED BY THE STATE FOR INCLUSION IN THIS PANEL (E.G.                                                                                                                                                                                                                                            
S362000300QGALACTOSE; HEMOGLOBIN, ELECTROPHORESIS;  HYDROXYPROGESTERONE, 17-D; PHENYLANINE                                                                                                                                                                                                                                      
S362000400Q(PKU); AND THYROXINE, TOTAL)                                                                                                                                                                                                                                                                                         
S362500100PMATERNAL SERUM TRIPLE MARKER SCREEN INCLUDING ALPHA-FETOPROTEIN (AFP), ESTRIOL, Maternal triple screen test 00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S362500200QAND HUMAN CHORIONIC GONADOTROPIN (HCG)                                                                                                                                                                                                                                                                               
S362600100PMATERNAL SERUM QUADRUPLE MARKER SCREEN INCLUDING ALPHA-FETOPROTEIN (AFP),       Maternal serum quad screen  00      9                                                                                                     I                          Z2  9       2005100120051001        A                           
S362600200QESTRIOL, HUMAN CHORIONIC GONADOTROPIN (HCG) AND INHIBIN A                                                                                                                                                                                                                                                            
S363000100PEOSINOPHIL COUNT, BLOOD, DIRECT                                                 Eosinophil blood count      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S364500100PHIV-1 ANTIBODY TESTING OF ORAL MUCOSAL TRANSUDATE                               HIV-1 antibody testing of or00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S365000100PSALIVA TEST, HORMONE LEVEL; DURING MENOPAUSE                                    Saliva test, hormone level; 00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S365200100PSALIVA TEST, HORMONE LEVEL; TO ASSESS PRETERM LABOR RISK                        Saliva test, hormone level; 00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S365500100PANTISPERM ANTIBODIES TEST (IMMUNOBEAD)                                          Antisperm antibodies test   00      9                                                                                                     I                          Z2  9       2002100120021001        N                           
S370100100PIMMUNOASSAY FOR NUCLEAR MATRIX PROTEIN 22 (NMP-22), QUANTITATIVE                NMP-22 assay                00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S370800100PGASTROINTESTINAL FAT ABSORPTION STUDY                                           Gastrointestinal fat absorpt00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S381800100PCOMPLETE GENE SEQUENCE ANALYSIS; BRCA1 GENE                                     BRCA1 gene anal             00      9                                                                                                     I                      0088Z2  5       2001070120010701        N                           
S381900100PCOMPLETE GENE SEQUENCE ANALYSIS; BRCA2 GENE                                     BRCA2 gene anal             00      9                                                                                                     I                      0088Z2  5       2001070120010701        N                           
S382000100PCOMPLETE BRCA1 AND BRCA2 GENE SEQUENCE ANALYSIS FOR SUSCEPTIBILITY TO BREAST    Comp BRCA1/BRCA2            00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S382000200QAND OVARIAN CANCER                                                                                                                                                                                                                                                                                                   
S382200100PSINGLE MUTATION ANALYSIS (IN INDIVIDUAL WITH A KNOWN BRCA1 OR BRCA2 MUTATION IN Sing mutation brst/ovar     00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S382200200QTHE FAMILY) FOR SUSCEPTIBILITY TO BREAST AND OVARIAN CANCER                                                                                                                                                                                                                                                          
S382300100PTHREE-MUTATION BRCA1 AND BRCA2 ANALYSIS FOR SUSCEPTIBILITY TO BREAST AND        3 mutation brst/ovar        00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S382300200QOVARIAN CANCER IN ASHKENAZI INDIVIDUALS                                                                                                                                                                                                                                                                              
S382800100PCOMPLETE GENE SEQUENCE ANALYSIS; MLH1 GENE                                      Comp MLH1 gene              00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S382900100PCOMPLETE GENE SEQUENCE ANALYSIS; MLH2 GENE                                      Comp MLH2 gene              00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S383000100PCOMPLETE MLH1 AND MLH2 GENE SEQUENCE ANALYSIS FOR HEREDITARY NONPOLYPOSIS       Gene test HNPCC comp        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S383000200QCOLORECTAL CANCER (HNPCC) GENETIC TESTING                                                                                                                                                                                                                                                                            
S383100100PSINGLE-MUTATION ANALYSIS (IN INDIVIDUAL WITH A KNOWN MLH1 AND MLH2 MUTATION IN  Gene test HNPCC single      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S383100200QTHE FAMILY) FOR HEREDITARY NONPOLYPOSIS COLORECTAL CANCER (HNPCC) GENETIC                                                                                                                                                                                                                                            
S383100300QTESTING                                                                                                                                                                                                                                                                                                              
S383300100PCOMPLETE APC GENE SEQUENCE ANALYSIS FOR SUSCEPTIBILITY TO FAMILIAL ADENOMATOUS  Comp APC sequence           00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S383300200QPOLYPOSIS (FAP) AND ATTENUATED FAP                                                                                                                                                                                                                                                                                   
S383400100PSINGLE-MUTATION ANALYSIS (IN INDIVIDUAL WITH A KNOWN APC MUTATION IN THE        Sing mutation APC           00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S383400200QFAMILY) FOR SUSCEPTIBILITY TO FAMILIAL ADENOMATOUS POLYPOSIS (FAP) AND                                                                                                                                                                                                                                               
S383400300QATTENUATED FAP                                                                                                                                                                                                                                                                                                       
S383500100PCOMPLETE GENE SEQUENCE ANALYSIS FOR CYSTIC FIBROSIS GENETIC TESTING             Gene test cystic fibrosis   00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S383700100PCOMPLETE GENE SEQUENCE ANALYSIS FOR HEMOCHROMATOSIS GENETIC TESTING             Gene test hemochromato      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S384000100PDNA ANALYSIS FOR GERMLINE MUTATIONS OF THE RET PROTO-ONCOGENE FOR               DNA analysis RET-oncogene   00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S384000200QSUSCEPTIBILITY TO MULTIPLE ENDOCRINE NEOPLASIA TYPE 2                                                                                                                                                                                                                                                                
S384100100PGENETIC TESTING FOR RETINOBLASTOMA                                              Gene test retinoblastoma    00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S384200100PGENETIC TESTING FOR VON HIPPEL-LINDAU DISEASE                                   Gene test Hippel-Lindau     00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S384300100PDNA ANALYSIS OF THE F5 GENE FOR SUSCEPTIBILITY TO FACTOR V LEIDEN THROMBOPHILIA DNA analysis factor v       00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S384400100PDNA ANALYSIS OF THE CONNEXIN 26 GENE (GJB2) FOR SUSCEPTIBILITY TO CONGENITAL,   DNA analysis deafness       00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S384400200QPROFOUND DEAFNESS                                                                                                                                                                                                                                                                                                    
S384500100PGENETIC TESTING FOR ALPHA-THALASSEMIA                                           Gene test alpha-thalassemia 00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S384600100PGENETIC TESTING FOR HEMOGLOBIN E BETA-THALASSEMIA                               Gene test beta-thalassemia  00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S384700100PGENETIC TESTING FOR TAY-SACHS DISEASE                                           Gene test Tay-Sachs         00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S384800100PGENETIC TESTING FOR GAUCHER DISEASE                                             Gene test Gaucher           00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S384900100PGENETIC TESTING FOR NIEMANN-PICK DISEASE                                        Gene test Niemann-Pick      00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S385000100PGENETIC TESTING FOR SICKLE CELL ANEMIA                                          Gene test sickle cell       00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S385100100PGENETIC TESTING FOR CANAVAN DISEASE                                             Gene test canavan           00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S385200100PDNA ANALYSIS FOR APOE EPSILON 4 ALLELE FOR SUSCEPTIBILITY TO ALZHEIMER'S DISEASEDNA analysis APOE alzheimer 00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S385300100PGENETIC TESTING FOR MYOTONIC MUSCULAR DYSTROPHY                                 Gene test myo musclr dyst   00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
S385400100PGENE EXPRESSION PROFILING PANEL FOR USE IN THE MANAGEMENT OF BREAST CANCER      Gene profile panel breast   00      9                                                                                                     I                          Z2  9       2006010120060101        A                           
S385400200QTREATMENT                                                                                                                                                                                                                                                                                                            
S389000100PDNA ANALYSIS, FECAL, FOR COLORECTAL CANCER SCREENING                            Fecal DNA analysis          00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S390000100PSURFACE ELECTROMYOGRAPHY (EMG)                                                  Surface EMG                 00      9                                                                                                     I                      0088Z2  9       2001070120010701        N                           
S390200100PBALLISTOCARDIOGRAM                                                              Ballistocardiogram          00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S390400100PMASTERS TWO STEP                                                                Masters two step            00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S400500100PINTERIM LABOR FACILITY GLOBAL (LABOR OCCURRING BUT NOT RESULTING IN DELIVERY)   Interim labor facility globa00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S401100100PIN VITRO FERTILIZATION; INCLUDING BUT NOT LIMITED TO IDENTIFICATION AND         IVF package                 00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S401100200QINCUBATION OF MATURE OOCYTES, FERTILIZATION WITH SPERM, INCUBATION OF                                                                                                                                                                                                                                                
S401100300QEMBRYO(S), AND SUBSEQUENT VISUALIZATION FOR DETERMINATION OF DEVELOPMENT                                                                                                                                                                                                                                             
S401300100PCOMPLETE CYCLE, GAMETE INTRAFALLOPIAN TRANSFER (GIFT), CASE RATE                Compl GIFT case rate        00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S401400100PCOMPLETE CYCLE, ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT), CASE RATE                Compl ZIFT case rate        00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S401500100PCOMPLETE IN VITRO FERTILIZATION CYCLE, NOT OTHERWISE SPECIFIED, CASE RATE       Complete IVF nos case rate  00      9                                                                                                     I                      0088Z2  9       2002010120020401        N                           
S401600100PFROZEN IN VITRO FERTILIZATION CYCLE, CASE RATE                                  Frozen IVF case rate        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S401700100PINCOMPLETE CYCLE, TREATMENT CANCELLED PRIOR TO STIMULATION, CASE RATE           IVF canc a stim case rate   00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S401800100PFROZEN EMBRYO TRANSFER PROCEDURE CANCELLED BEFORE TRANSFER, CASE RATE           F EMB trns canc case rate   00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S402000100PIN VITRO FERTILIZATION PROCEDURE CANCELLED BEFORE ASPIRATION, CASE RATE         IVF canc a aspir case rate  00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S402100100PIN VITRO FERTILIZATION PROCEDURE CANCELLED AFTER ASPIRATION, CASE RATE          IVF canc p aspir case rate  00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S402200100PASSISTED OOCYTE FERTILIZATION, CASE RATE                                        Asst oocyte fert case rate  00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S402300100PDONOR EGG CYCLE, INCOMPLETE, CASE RATE                                          Incompl donor egg case rate 00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S402500100PDONOR SERVICES FOR IN VITRO FERTILIZATION (SPERM OR EMBRYO), CASE RATE          Donor serv IVF case rate    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S402600100PPROCUREMENT OF DONOR SPERM FROM SPERM BANK                                      Procure donor sperm         00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S402700100PSTORAGE OF PREVIOUSLY FROZEN EMBRYOS                                            Store prev froz embryos     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S402800100PMICROSURGICAL EPIDIDYMAL SPERM ASPIRATION (MESA)                                Microsurg epi sperm asp     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S403000100PSPERM PROCUREMENT AND CRYOPRESERVATION SERVICES; INITIAL VISIT                  Sperm procure init visit    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S403100100PSPERM PROCUREMENT AND CRYOPRESERVATION SERVICES; SUBSEQUENT VISIT               Sperm procure subs visit    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S403500100PSTIMULATED INTRAUTERINE INSEMINATION (IUI), CASE RATE                           Stimulated IUI case rate    00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S403600100PINTRAVAGINAL CULTURE (IVC), CASE RATE                                           Intravag cult case rate     00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S403700100PCRYOPRESERVED EMBRYO TRANSFER, CASE RATE                                        Cryo embryo transf case rate00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S404000100PMONITORING AND STORAGE OF CRYOPRESERVED EMBRYOS, PER 30 DAYS                    Monit store cryo embryo 30 d00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S404200100PMANAGEMENT OF OVULATION INDUCTION (INTERPRETATION OF DIAGNOSTIC TESTS AND       Ovulation mgmt per cycle    00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
S404200200QSTUDIES, NON-FACE-TO-FACE MEDICAL MANAGEMENT OF THE PATIENT), PER CYCLE                                                                                                                                                                                                                                              
S498100100PINSERTION OF LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM                       Insert levonorgestrel ius   00      9                                                                                                     I                      0088Z2  2       2001070120010701        N                           
S498900100PCONTRACEPTIVE INTRAUTERINE DEVICE (E.G. PROGESTACERT IUD), INCLUDING IMPLANTS   Contracept IUD              00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S498900200QAND SUPPLIES                                                                                                                                                                                                                                                                                                         
S499000100PNICOTINE PATCHES, LEGEND                                                        Nicotine patch legend       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S499100100PNICOTINE PATCHES, NON-LEGEND                                                    Nicotine patch nonlegend    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S499300100PCONTRACEPTIVE PILLS FOR BIRTH CONTROL                                           Contraceptive pills for bc  00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S499500100PSMOKING CESSATION GUM                                                           Smoking cessation gum       00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S500000100PPRESCRIPTION DRUG, GENERIC                                                      Prescription drug, generic  00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S500100100PPRESCRIPTION DRUG, BRAND NAME                                                   Prescription drug,brand name00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S501000100P5% DEXTROSE AND 0.45% NORMAL SALINE, 1000 ML                                    5% dextrose and 0.45% saline00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S501100100P5% DEXTROSE IN LACTATED RINGER'S, 1000 ML                                       5% dextrose in lactated ring00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S501200100P5% DEXTROSE WITH POTASSIUM CHLORIDE, 1000 ML                                    5% dextrose with potassium  00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S501300100P5% DEXTROSE/0.45% NORMAL SALINE WITH POTASSIUM CHLORIDE AND MAGNESIUM SULFATE,  5%dextrose/0.45%saline1000ml00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S501300200Q1000 ML                                                                                                                                                                                                                                                                                                              
S501400100P5% DEXTROSE/0.45% NORMAL SALINE WITH POTASSIUM CHLORIDE AND MAGNESIUM SULFATE,  D5W/0.45NS w KCl and MGS04  00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S501400200Q1500 ML                                                                                                                                                                                                                                                                                                              
S503500100PHOME INFUSION THERAPY, ROUTINE SERVICE OF INFUSION DEVICE (E.G. PUMP            HIT routine device maint    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S503500200QMAINTENANCE)                                                                                                                                                                                                                                                                                                         
S503600100PHOME INFUSION THERAPY, REPAIR OF INFUSION DEVICE (E.G. PUMP REPAIR)             HIT device repair           00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S510000100PDAY CARE SERVICES, ADULT; PER 15 MINUTES                                        Adult daycare services 15min00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S510100100PDAY CARE SERVICES, ADULT; PER HALF DAY                                          Adult day care per half day 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S510200100PDAY CARE SERVICES, ADULT; PER DIEM                                              Adult day care per diem     00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S510500100PDAY CARE SERVICES, CENTER-BASED; SERVICES NOT INCLUDED IN PROGRAM FEE, PER DIEM Centerbased day care perdiem00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S510800100PHOME CARE TRAINING TO HOME CARE CLIENT, PER 15 MINUTES                          Homecare train pt 15 min    00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S510900100PHOME CARE TRAINING TO HOME CARE CLIENT, PER SESSION                             Homecare train pt session   00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S511000100PHOME CARE TRAINING, FAMILY; PER 15 MINUTES                                      Family homecare training 15m00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S511100100PHOME CARE TRAINING, FAMILY; PER SESSION                                         Family homecare train/sessio00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S511500100PHOME CARE TRAINING, NON-FAMILY; PER 15 MINUTES                                  Nonfamily homecare train/15m00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S511600100PHOME CARE TRAINING, NON-FAMILY; PER SESSION                                     Nonfamily HC train/session  00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S512000100PCHORE SERVICES; PER 15 MINUTES                                                  Chore services per 15 min   00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S512100100PCHORE SERVICES; PER DIEM                                                        Chore services per diem     00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S512500100PATTENDANT CARE SERVICES; PER 15 MINUTES                                         Attendant care service /15m 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S512600100PATTENDANT CARE SERVICES; PER DIEM                                               Attendant care service /diem00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S513000100PHOMEMAKER SERVICE, NOS; PER 15 MINUTES                                          Homaker service nos per 15m 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S513100100PHOMEMAKER SERVICE, NOS; PER DIEM                                                Homemaker service nos /diem 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S513500100PCOMPANION CARE, ADULT (E.G. IADL/ADL); PER 15 MINUTES                           Adult companioncare per 15m 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S513600100PCOMPANION CARE, ADULT (E.G. IADL/ADL); PER DIEM                                 Adult companioncare per diem00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S514000100PFOSTER CARE, ADULT; PER DIEM                                                    Adult foster care per diem  00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S514100100PFOSTER CARE, ADULT; PER MONTH                                                   Adult foster care per month 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S514500100PFOSTER CARE, THERAPEUTIC, CHILD; PER DIEM                                       Child fostercare th per diem00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S514600100PFOSTER CARE, THERAPEUTIC, CHILD; PER MONTH                                      Ther fostercare child /month00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S515000100PUNSKILLED RESPITE CARE, NOT HOSPICE; PER 15 MINUTES                             Unskilled respite care /15m 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S515100100PUNSKILLED RESPITE CARE, NOT HOSPICE; PER DIEM                                   Unskilled respitecare /diem 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S516000100PEMERGENCY RESPONSE SYSTEM; INSTALLATION AND TESTING                             Emer response sys instal&tst00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S516100100PEMERGENCY RESPONSE SYSTEM; SERVICE FEE, PER MONTH (EXCLUDES INSTALLATION AND    Emer rspns sys serv permonth00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S516100200QTESTING)                                                                                                                                                                                                                                                                                                             
S516200100PEMERGENCY RESPONSE SYSTEM; PURCHASE ONLY                                        Emer rspns system purchase  00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S516500100PHOME MODIFICATIONS; PER SERVICE                                                 Home modifications per serv 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S517000100PHOME DELIVERED MEALS, INCLUDING PREPARATION; PER MEAL                           Homedelivered prepared meal 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S517500100PLAUNDRY SERVICE, EXTERNAL, PROFESSIONAL; PER ORDER                              Laundry serv,ext,prof,/order00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S518000100PHOME HEALTH RESPIRATORY THERAPY, INITIAL EVALUATION                             HH respiratory thrpy in eval00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S518100100PHOME HEALTH RESPIRATORY THERAPY, NOS, PER DIEM                                  HH respiratory thrpy nos/day00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S518500100PMEDICATION REMINDER SERVICE, NON-FACE-TO-FACE; PER MONTH                        Med reminder serv per month 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S519000100PWELLNESS ASSESSMENT, PERFORMED BY NON-PHYSICIAN                                 Wellness assessment by nonph00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S519900100PPERSONAL CARE ITEM, NOS, EACH                                                   Personal care item nos each 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S549700100PHOME INFUSION THERAPY, CATHETER CARE / MAINTENANCE, NOT OTHERWISE CLASSIFIED;   HIT cath care noc           00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S549700200QINCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S549700300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S549700400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S549800100PHOME INFUSION THERAPY, CATHETER CARE / MAINTENANCE, SIMPLE (SINGLE LUMEN),      HIT simple cath care        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S549800200QINCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S549800300QCOORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT, (DRUGS AND NURSING                                                                                                                                                                                                                                            
S549800400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S550100100PHOME INFUSION THERAPY, CATHETER CARE / MAINTENANCE, COMPLEX (MORE THAN ONE      HIT complex cath care       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S550100200QLUMEN), INCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                       
S550100300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S550100400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S550200100PHOME INFUSION THERAPY, CATHETER CARE / MAINTENANCE, IMPLANTED ACCESS DEVICE,    HIT interim cath care       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S550200200QINCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S550200300QCOORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT, (DRUGS AND NURSING                                                                                                                                                                                                                                            
S550200400QVISITS CODED SEPARATELY), PER DIEM (USE THIS CODE FOR INTERIM MAINTENANCE OF                                                                                                                                                                                                                                         
S550200500QVASCULAR ACCESS NOT CURRENTLY IN USE)                                                                                                                                                                                                                                                                                
S551700100PHOME INFUSION THERAPY, ALL SUPPLIES NECESSARY FOR RESTORATION OF CATHETER       HIT declotting kit          00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S551700200QPATENCY OR DECLOTTING                                                                                                                                                                                                                                                                                                
S551800100PHOME INFUSION THERAPY, ALL SUPPLIES NECESSARY FOR CATHETER REPAIR               HIT cath repair kit         00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S552000100PHOME INFUSION THERAPY, ALL SUPPLIES (INCLUDING CATHETER) NECESSARY FOR A        HIT picc insert kit         00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S552000200QPERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC) LINE INSERTION                                                                                                                                                                                                                                                  
S552100100PHOME INFUSION THERAPY, ALL SUPPLIES (INCLUDING CATHETER) NECESSARY FOR A        HIT midline cath insert kit 00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S552100200QMIDLINE CATHETER INSERTION                                                                                                                                                                                                                                                                                           
S552200100PHOME INFUSION THERAPY, INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS        HIT picc insert no supp     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S552200200QCATHETER (PICC), NURSING SERVICES ONLY (NO SUPPLIES OR CATHETER INCLUDED)                                                                                                                                                                                                                                            
S552300100PHOME INFUSION THERAPY, INSERTION OF MIDLINE CENTRAL VENOUS CATHETER, NURSING    HIP midline cath insert kit 00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S552300200QSERVICES ONLY (NO SUPPLIES OR CATHETER INCLUDED)                                                                                                                                                                                                                                                                     
S555000100PINSULIN, RAPID ONSET, 5 UNITS                                                   Insulin rapid 5 u           00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S555100100PINSULIN, MOST RAPID ONSET (LISPRO OR ASPART); 5 UNITS                           Insulin most rapid 5 u      00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S555200100PINSULIN, INTERMEDIATE ACTING (NPH OR LENTE); 5 UNITS                            Insulin intermed 5 u        00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S555300100PINSULIN, LONG ACTING; 5 UNITS                                                   Insulin long acting 5 u     00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S556000100PINSULIN DELIVERY DEVICE, REUSABLE PEN; 1.5 ML SIZE                              Insulin reuse pen 1.5 ml    00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S556100100PINSULIN DELIVERY DEVICE, REUSABLE PEN; 3 ML SIZE                                Insulin reuse pen 3 ml      00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S556500100PINSULIN CARTRIDGE FOR USE IN INSULIN DELIVERY DEVICE OTHER THAN PUMP; 150 UNITS Insulin cartridge 150 u     00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S556600100PINSULIN CARTRIDGE FOR USE IN INSULIN DELIVERY DEVICE OTHER THAN PUMP; 300 UNITS Insulin cartridge 300 u     00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S557000100PINSULIN DELIVERY DEVICE, DISPOSABLE PEN (INCLUDING INSULIN); 1.5 ML SIZE        Insulin dispos pen 1.5 ml   00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S557100100PINSULIN DELIVERY DEVICE, DISPOSABLE PEN (INCLUDING INSULIN); 3 ML SIZE          Insulin dispos pen 3 ml     00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S800200100PSUPPLY OF DIAGNOSTIC RADIOPHARMACEUTICAL, INDIUM-111                            Ibritumomab tiuxetan        00      9                                                                            A9522                    I                          Z2  1       200210012003010120021231N                           
S800300100PSUPPLY OF THERAPEUTIC RADIOIMMUNOPHARMACEUTICAL, YTTRIUM-90                     Ibritumomab tiuxetan,perdose00      9                                                                            A9523                    I                          Z2  1       200210012003010120021231N                           
S800400100PRADIOIMMUNOPHARMACEUTICAL LOCALIZATION OF TARGETED CELLS; WHOLE BODY            Wholebody radiopharm trgcell00      9                                                                            78804                    I                          Z2  9       200301012005040120050331D                           
S803000100PSCLERAL APPLICATION OF TANTALUM RING(S) FOR LOCALIZATION OF LESIONS FOR PROTON  Tantalum ring application   00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S803000200QBEAM THERAPY                                                                                                                                                                                                                                                                                                         
S803500100PMAGNETIC SOURCE IMAGING                                                         Magnetic source imaging     00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S803700100PMAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP)                              mrcp                        00      9                                                                                                     I                      0088Z2  4       2001070120010701        N                           
S804000100PTOPOGRAPHIC BRAIN MAPPING                                                       Topographic brain mapping   00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S804200100PMAGNETIC RESONANCE IMAGING (MRI), LOW-FIELD                                     MRI low field               00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S804900100PINTRAOPERATIVE RADIATION THERAPY (SINGLE ADMINISTRATION)                        Intraoperative radiation the00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S805500100PULTRASOUND GUIDANCE FOR MULTIFETAL PREGNANCY REDUCTION(S), TECHNICAL COMPONENT  Us guidance fetal reduct    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S805500200Q(ONLY TO BE USED WHEN THE PHYSICIAN DOING THE REDUCTION PROCEDURE DOES NOT                                                                                                                                                                                                                                           
S805500300QPERFORM THE ULTRASOUND, GUIDANCE IS INCLUDED IN THE CPT CODE FOR MULTIFETAL                                                                                                                                                                                                                                          
S805500400QPREGNANCY REDUCTION - 59866)                                                                                                                                                                                                                                                                                         
S807500100PCOMPUTER ANALYSIS OF FULL-FIELD DIGITAL MAMMOGRAM AND FURTHER PHYSICIAN REVIEW  CAD of digital mammogr      00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
S807500200QFOR INTERPRETATION, MAMMOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FOR                                                                                                                                                                                                                                             
S807500300QPRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                                   
S808000100PSCINTIMAMMOGRAPHY (RADIOIMMUNOSCINTIGRAPHY OF THE BREAST), UNILATERAL,          Scintimammography           00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S808000200QINCLUDING SUPPLY OF RADIOPHARMACEUTICAL                                                                                                                                                                                                                                                                              
S808500100PFLUORINE-18 FLUORODEOXYGLUCOSE (F-18 FDG) IMAGING USING DUAL-HEAD COINCIDENCE   Fluorine-18 fluorodeoxygluco00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S808500200QDETECTION SYSTEM (NON-DEDICATED PET SCAN)                                                                                                                                                                                                                                                                            
S809200100PELECTRON BEAM COMPUTED TOMOGRAPHY (ALSO KNOWN AS ULTRAFAST CT, CINE CT)         Electron beam computed tomog00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S809300100PCOMPUTED TOMOGRAPHIC ANGIOGRAPHY, CORONARY ARTERIES, WITH CONTRAST MATERIAL(S)  CT angiography coronary     00      9                                                                                                     I                          Z2  9       2004100120041001        N                           
S809500100PWIG (FOR MEDICALLY-INDUCED OR CONGENITAL HAIR LOSS)                             Wig (for medically-induced h00      9                                                                                                     I                      0088Z2  9       200001012006010120051231D                           
S809600100PPORTABLE PEAK FLOW METER                                                        Portable peak flow meter    00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S809700100PASTHMA KIT (INCLUDING BUT NOT LIMITED TO PORTABLE PEAK EXPIRATORY FLOW METER,   Asthma kit                  00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S809700200QINSTRUCTIONAL VIDEO, BROCHURE, AND/OR SPACER)                                                                                                                                                                                                                                                                        
S810000100PHOLDING CHAMBER OR SPACER FOR USE WITH AN INHALER OR NEBULIZER; WITHOUT MASK    Spacer without mask         00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S810100100PHOLDING CHAMBER OR SPACER FOR USE WITH AN INHALER OR NEBULIZER; WITH MASK       Spacer with mask            00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S810500100POXIMETER FOR MEASURING BLOOD OXYGEN LEVELS NONINVASIVELY                        Oximeter for measuring blood00      9                                                                                                     I                      0088Z2  9       200101012003010120021231N                           
S811000100PPEAK EXPIRATORY FLOW RATE (PHYSICIAN SERVICES)                                  Peak expiratory flow rate (p00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S812000100POXYGEN CONTENTS, GASEOUS, 1 UNIT EQUALS 1 CUBIC FOOT                            O2 contents gas cubic ft    00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S812100100POXYGEN CONTENTS, LIQUID, 1 UNIT EQUALS 1 POUND                                  O2 contents liquid lb       00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S818000100PTRACHEOSTOMY SHOWER PROTECTOR                                                   Trach shower protector      00      9                                                                                                     I                      0088Z2  9       200201012004010120031231N                           
S818100100PTRACHEOSTOMY TUBE HOLDER                                                        Trach tube holder           00      9                                                                                                     I                      0088Z2  9       200201012004010120031231N                           
S818200100PHUMIDIFIER, HEATED, USED WITH VENTILATOR, NON-SERVO-CONTROLLED                  Humidifier non-servo        00      9                                                                                                     I                      0088Z2  9       200201012005010120041231N                           
S818300100PHUMIDIFIER, HEATED, USED WITH VENTILATOR, DUAL SERVO-CONTROLLED WITH            Humidifier dual servo       00      9                                                                                                     I                      0088Z2  9       200201012005010120041231N                           
S818300200QTEMPERATURE MONITORING                                                                                                                                                                                                                                                                                               
S818500100PFLUTTER DEVICE                                                                  Flutter device              00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S818600100PSWIVEL ADAPTOR                                                                  Swivel adaptor              00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S818900100PTRACHEOSTOMY SUPPLY, NOT OTHERWISE CLASSIFIED                                   Trach supply noc            00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S819000100PELECTRONIC SPIROMETER (OR MICROSPIROMETER)                                      Electronic spirometer       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S820000100PCHEST COMPRESSION VEST                                                          Chest compression vest      00      9                                                                            E0483                    I                      0088Z2  9       200001012003010120021231N                           
S820500100PCHEST COMPRESSION SYSTEM GENERATOR AND HOSES (FOR USE WITH CHEST  COMPRESSION   Chest compression system gen00      9                                                                            E0483                    I                      0088Z2  9       200001012003010120021231N                           
S820500200QVEST - S8200)                                                                                                                                                                                                                                                                                                        
S821000100PMUCUS TRAP                                                                      Mucus trap                  00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S826000100PORAL ORTHOTIC FOR TREATMENT OF SLEEP APNEA, INCLUDES FITTING, FABRICATION, AND  Oral orthotic for treatment 00      9                                                                                                     I                      0088Z2  P       2000010120000101        N                           
S826000200QMATERIALS                                                                                                                                                                                                                                                                                                            
S826200100PMANDIBULAR ORTHOPEDIC REPOSITIONING DEVICE, EACH                                Mandib ortho repos device   00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S826500100PHABERMAN FEEDER FOR CLEFT LIP/PALATE                                            Haberman feeder             00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S827000100PENURESIS ALARM, USING AUDITORY BUZZER AND/OR VIBRATION DEVICE                   Enuresis alarm              00      9                                                                                                     I                          Z2  9       2005070120050701        A                           
S830100100PINFECTION CONTROL SUPPLIES, NOT OTHERWISE SPECIFIED                             Infect control supplies NOS 00      9                                                                                                     I                          Z2  9       2004070120040701        N                           
S840100100PCHILD-SIZE INCONTINENCE GARMENT, DIAPER, EACH                                   Child-size diaper           00      9                                                                            A4529A4530               I                      0088Z2  9       200201012003010120021231N                           
S840300100PADULT-SIZED INCONTINENCE GARMENT, DISPOSABLE, PULL-UP BRIEF, EACH               Adult-size pull-up brief    00      9                                                                            A4525A4526A4527A4528     I                      0088Z2  9       200201012003010120021231N                           
S840400100PCHILD-SIZE INCONTINENCE GARMENT, DISPOSABLE, PULL-UP BRIEF, EACH                Child-size pull-up brief    00      9                                                                            A4531A4532               I                      0088Z2  9       200201012003010120021231N                           
S840500100PDISPOSABLE LINER/SHIELD FOR INCONTINENCE, EACH                                  Incontinence liners, each   00      9                                                                            A4535                    I                      0088Z2  9       200101012003010120021231N                           
S841500100PSUPPLIES FOR HOME DELIVERY OF INFANT                                            Supplies for home delivery  00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842000100PGRADIENT PRESSURE AID (SLEEVE AND GLOVE COMBINATION), CUSTOM MADE               Custom gradient sleev/glov  00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842100100PGRADIENT PRESSURE AID (SLEEVE AND GLOVE COMBINATION), READY MADE                Ready gradient sleev/glov   00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842200100PGRADIENT PRESSURE AID (SLEEVE), CUSTOM MADE, MEDIUM WEIGHT                      Custom grad sleeve med      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842300100PGRADIENT PRESSURE AID (SLEEVE), CUSTOM MADE, HEAVY WEIGHT                       Custom grad sleeve heavy    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842400100PGRADIENT PRESSURE AID (SLEEVE), READY MADE                                      Ready gradient sleeve       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842500100PGRADIENT PRESSURE AID (GLOVE), CUSTOM MADE, MEDIUM WEIGHT                       Custom grad glove med       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842600100PGRADIENT PRESSURE AID (GLOVE), CUSTOM MADE, HEAVY WEIGHT                        Custom grad glove heavy     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842700100PGRADIENT PRESSURE AID (GLOVE), READY MADE                                       Ready gradient glove        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842800100PGRADIENT PRESSURE AID (GAUNTLET), READY MADE                                    Ready gradient gauntlet     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S842900100PGRADIENT PRESSURE EXTERIOR WRAP                                                 Gradient pressure wrap      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S843000100PPADDING FOR COMPRESSION BANDAGE, ROLL                                           Padding for comprssn bdg    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S843100100PCOMPRESSION BANDAGE, ROLL                                                       Compression bandage         00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S843300100PSKIN SUPPORT FOR BREAST PROSTHESIS, EACH                                        Skin support/breast prosth  00      9                                                                            A4280                    I                          Z2  9       200204012003010120021231N                           
S843400100PINTERIM POST-OPERATIVE ORTHOTIC DEVICE FOR UPPER EXTREMITY, CUSTOM MADE         Interim splint upper extrem 00      9                                                                                                     I                          Z2  9       200504012006010120051231D                           
S845000100PSPLINT, PREFABRICATED, DIGIT (SPECIFY DIGIT BY USE OF MODIFIER)                 Splint digit                00      9                                                                                                     I                      0088Z2  P       2002010120020101        N                           
S845100100PSPLINT, PREFABRICATED, WRIST OR ANKLE                                           Splint wrist or ankle       00      9                                                                                                     I                      0088Z2  P       2002010120020101        N                           
S845200100PSPLINT, PREFABRICATED, ELBOW                                                    Splint elbow                00      9                                                                                                     I                      0088Z2  P       2002010120020101        N                           
S846000100PCAMISOLE, POST-MASTECTOMY                                                       Camisole post-mast          00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S847000100PPOSITIONING DEVICE, STANDER, FOR USE BY PATIENT WHO IS UNABLE TO STAND          Stander positioning device  00      9                                                                                                     I                          Z2  9       200307012004010120031231N                           
S847000200QINDEPENDENTLY (E.G. CEREBRAL PALSY PATIENT)                                                                                                                                                                                                                                                                          
S849000100PINSULIN SYRINGES (100 SYRINGES, ANY SIZE)                                       100 insulin syringes        00      9                                                                                                     I                      0088Z2  S       2002010120020101        N                           
S894000100PEQUESTRIAN/HIPPOTHERAPY, PER SESSION                                            Hippotherapy per session    00      9                                                                                                     I                          Z2  9       2005040120050401        A                           
S894500100PPHYSICAL MEDICINE TREATMENT (CONSTANT ATTENDANCE BY PROVIDER) TO ONE AREA,      PT phonophoresis 30 mins    00      9                                                                                                     I                          Z2  9       200204012003040120030331N                           
S894500200QINITIAL 30 MINUTES, EACH VISIT; PHONOPHORESIS                                                                                                                                                                                                                                                                        
S894800100PAPPLICATION OF A MODALITY (REQUIRING CONSTANT PROVIDER ATTENDANCE) TO ONE OR    Low-level laser trmt 15 min 00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
S894800200QMORE AREAS; LOW-LEVEL LASER; EACH 15 MINUTES                                                                                                                                                                                                                                                                         
S895000100PCOMPLEX LYMPHEDEMA THERAPY, EACH 15 MINUTES                                     Complex lymphedema therapy, 00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S899000100PPHYSICAL OR MANIPULATIVE THERAPY PERFORMED FOR MAINTENANCE RATHER THAN          Pt or manip for maint       00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S899000200QRESTORATION                                                                                                                                                                                                                                                                                                          
S899900100PRESUSCITATION BAG (FOR USE BY PATIENT ON ARTIFICIAL RESPIRATION DURING POWER    Resuscitation bag           00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S899900200QFAILURE OR OTHER CATASTROPHIC EVENT)                                                                                                                                                                                                                                                                                 
S900100100PHOME UTERINE MONITOR WITH OR WITHOUT ASSOCIATED NURSING SERVICES                Home uterine monitor with or00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S900700100PULTRAFILTRATION MONITOR                                                         Ultrafiltration monitor     00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S901500100PAUTOMATED EEG MONITORING                                                        Automated EEG monitoring    00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S902200100PDIGITAL SUBTRACTION ANGIOGRAPHY (USE IN ADDITION TO CPT CODE FOR THE PROCEDURE  Digital subtraction angiogra00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S902200200QFOR FURTHER IDENTIFICATION)                                                                                                                                                                                                                                                                                          
S902400100PPARANASAL SINUS ULTRASOUND                                                      Paranasal sinus ultrasound  00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S902500100POMNICARDIOGRAM/CARDIOINTEGRAM                                                   Omnicardiogram/cardiointegra00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S903400100PEXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR GALL STONES (IF PERFORMED WITH ERCP,   ESWL for gallstones         00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S903400200QUSE 43265)                                                                                                                                                                                                                                                                                                           
S905500100PPROCUREN OR OTHER GROWTH FACTOR PREPARATION TO PROMOTE WOUND HEALING            Procuren or other growth fac00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S905600100PCOMA STIMULATION PER DIEM                                                       Coma stimulation per diem   00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S906100100PHOME ADMINISTRATION OF AEROSOLIZED DRUG THERAPY (E.G., PENTAMIDINE);            Medical supplies and equipme00      9                                                                                                     I                      0088Z2  9       2001010120020101        N                           
S906100200QADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, ALL                                                                                                                                                                                                                                      
S906100300QNECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY),                                                                                                                                                                                                                                        
S906100400QPER DIEM                                                                                                                                                                                                                                                                                                             
S907500100PSMOKING CESSATION TREATMENT                                                     Smoking cessation treatment 00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S908300100PGLOBAL FEE URGENT CARE CENTERS                                                  Urgent care center global   00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S908800100PSERVICES PROVIDED IN AN URGENT CARE CENTER (LIST IN ADDITION TO CODE FOR        Services provided in urgent 00      9                                                                                                     I                      0088Z2  9       2001010120020101        N                           
S908800200QSERVICE)                                                                                                                                                                                                                                                                                                             
S909000100PVERTEBRAL AXIAL DECOMPRESSION, PER SESSION                                      Vertebral axial decompressio00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S909200100PCANOLITH REPOSITIONING, PER VISIT                                               Canolith repositioning      00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S909700100PHOME VISIT FOR WOUND CARE                                                       Home visit wound care       00      9                                                                                                     I                          Z2  9       2004100120041001        N                           
S909800100PHOME VISIT, PHOTOTHERAPY SERVICES (E.G. BILI-LITE), INCLUDING EQUIPMENT RENTAL, Home phototherapy visit     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S909800200QNURSING SERVICES, BLOOD DRAW, SUPPLIES, AND OTHER SERVICES, PER DIEM                                                                                                                                                                                                                                                 
S910900100PCONGESTIVE HEART FAILURE TELEMONITORING, EQUIPMENT RENTAL, INCLUDING TELESCALE, CHF telemonitoring month    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S910900200QCOMPUTER SYSTEM AND SOFTWARE, TELEPHONE CONNECTIONS, AND MAINTENANCE, PER MONTH                                                                                                                                                                                                                                      
S911700100PBACK SCHOOL, PER VISIT                                                          Back school visit           00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S912200100PHOME HEALTH AIDE OR CERTIFIED NURSE ASSISTANT, PROVIDING CARE IN THE HOME; PER  Home health aide or certifie00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S912200200QHOUR                                                                                                                                                                                                                                                                                                                 
S912300100PNURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR (USE FOR GENERAL       Nursing care in home RN     00      9                                                                                                     I                      0088Z2  9       2000010120040101        N                           
S912300200QNURSING CARE ONLY, NOT TO BE USED WHEN CPT CODES 99500-99602 CAN BE USED)                                                                                                                                                                                                                                            
S912400100PNURSING CARE, IN THE HOME; BY LICENSED PRACTICAL NURSE, PER HOUR                Nursing care, in the home; b00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S912500100PRESPITE CARE, IN THE HOME, PER DIEM                                             Respite care, in the home, p00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S912600100PHOSPICE CARE, IN THE HOME, PER DIEM                                             Hospice care, in the home, p00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S912700100PSOCIAL WORK VISIT, IN THE HOME, PER DIEM                                        Social work visit, in the ho00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S912800100PSPEECH THERAPY, IN THE HOME, PER DIEM                                           Speech therapy, in the home,00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S912900100POCCUPATIONAL THERAPY, IN THE HOME, PER DIEM                                     Occupational therapy, in the00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S913100100PPHYSICAL THERAPY; IN THE HOME, PER DIEM                                         PT in the home per diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S914000100PDIABETIC MANAGEMENT PROGRAM, FOLLOW-UP VISIT TO NON-MD PROVIDER                 Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S914100100PDIABETIC MANAGEMENT PROGRAM, FOLLOW-UP VISIT TO MD PROVIDER                     Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S914500100PINSULIN PUMP INITIATION, INSTRUCTION IN INITIAL USE OF PUMP (PUMP NOT INCLUDED) Insulin pump initiation     00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S915000100PEVALUATION BY OCULARIST                                                         Evaluation by ocularist     00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S920800100PHOME MANAGEMENT OF PRETERM LABOR, INCLUDING ADMINISTRATIVE SERVICES,            Home mgmt preterm labor     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S920800200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S920800300QOR EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT USE                                                                                                                                                                                                                                       
S920800400QTHIS CODE WITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                      
S920900100PHOME MANAGEMENT OF PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM), INCLUDING    Home mgmt PPROM             00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S920900200QADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S920900300QALL NECESSARY SUPPLIES OR EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                  
S920900400QSEPARATELY), PER DIEM (DO NOT USE THIS CODE WITH ANY HOME INFUSION PER DIEM                                                                                                                                                                                                                                          
S920900500QCODE)                                                                                                                                                                                                                                                                                                                
S921100100PHOME MANAGEMENT OF GESTATIONAL HYPERTENSION, INCLUDES ADMINISTRATIVE SERVICES,  Home mgmt gest hypertension 00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S921100200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                         
S921100300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY); PER DIEM (DO NOT USE                                                                                                                                                                                                                                      
S921100400QTHIS CODE WITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                      
S921200100PHOME MANAGEMENT OF POSTPARTUM HYPERTENSION, INCLUDES ADMINISTRATIVE SERVICES,   Hm postpar hyper per diem   00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S921200200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S921200300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT USE                                                                                                                                                                                                                                      
S921200400QTHIS CODE WITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                      
S921300100PHOME MANAGEMENT OF PREECLAMPSIA, INCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL Hm preeclamp per diem       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S921300200QPHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S921300300Q(DRUGS AND NURSING SERVICES CODED SEPARATELY); PER DIEM (DO NOT USE THIS CODE                                                                                                                                                                                                                                        
S921300400QWITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                                
S921400100PHOME MANAGEMENT OF GESTATIONAL DIABETES, INCLUDES ADMINISTRATIVE SERVICES,      Hm gest dm per diem         00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S921400200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S921400300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY); PER DIEM (DO NOT USE                                                                                                                                                                                                                                      
S921400400QTHIS CODE WITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                      
S921600100PNURSING SERVICES AND ALL NECESSARY EQUIPMENT AND SUPPLIES FOR GESTATIONAL       Gest hyper w nurs diem      00      9                                                                            S9211                    I                      0088Z2  9       200201012003010120021231N                           
S921600200QHYPERTENSION PROGRAM (INCLUDES MATERNAL ASSESSMENT AS NEEDED, TELEPHONIC                                                                                                                                                                                                                                             
S921600300QCOLLECTION OF BLOOD PRESSURE, URINE PROTEIN, WEIGHT AND FETAL MOVEMENT COUNTING                                                                                                                                                                                                                                      
S921600400QVIA A HOME DATA COLLECTION SYSTEM, PATIENT STATUS REPORTS, 24 HOUR/7 DAY A WEEK                                                                                                                                                                                                                                      
S921600500QNURSING SUPPORT, AND ALL EDUCATION TO THE PATIENT AND CAREGIVER); PER DIEM                                                                                                                                                                                                                                           
S921700100PNURSING SERVICES AND ALL NECESSARY EQUIPMENT AND SUPPLIES FOR POSTPARTUM        Postpar hyper w nurs diem   00      9                                                                            S9212                    I                      0088Z2  9       200201012003010120021231N                           
S921700200QHYPERTENSION PROGRAM (INCLUDES MATERNAL ASSESSMENT AS NEEDED, TELEPHONIC                                                                                                                                                                                                                                             
S921700300QCOLLECTION OF BLOOD PRESSURE, URINE PROTEIN, WEIGHT, COMPLIANCE MANAGEMENT                                                                                                                                                                                                                                           
S921700400QSUPPORT, PATIENT STATUS REPORTS, 24 HOUR/7 DAY A WEEK NURSING SUPPORT, AND ALL                                                                                                                                                                                                                                       
S921700500QEDUCATION TO THE PATIENT AND CAREGIVER); PER DIEM                                                                                                                                                                                                                                                                    
S921800100PNURSING SERVICES AND ALL NECESSARY EQUIPMENT AND SUPPLIES FOR PREECLAMPSIA      Preeclamp w nurs diem       00      9                                                                            S9213                    I                      0088Z2  9       200201012003010120021231N                           
S921800200QPROGRAM (INCLUDES MATERNAL ASSESSMENT AS NEEDED, TELEPHONIC COLLECTION OF BLOOD                                                                                                                                                                                                                                      
S921800300QPRESSURE, URINE PROTEIN, WEIGHT AND DAILY FETAL MOVEMENT COUNTS VIA A HOME DATA                                                                                                                                                                                                                                      
S921800400QCOLLECTION SYSTEM, COMPLIANCE MANAGEMENT SUPPORT, PATIENT STATUS REPORTS, 24                                                                                                                                                                                                                                         
S921800500QHOUR/7 DAY A WEEK NURSING SUPPORT, AND ALL EDUCATION TO THE PATIENT AND                                                                                                                                                                                                                                              
S921800600QCAREGIVER); PER DIEM                                                                                                                                                                                                                                                                                                 
S932500100PHOME INFUSION THERAPY, PAIN MANAGEMENT INFUSION; ADMINISTRATIVE SERVICES,       HIT pain mgmt per diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S932500200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S932500300QAND EQUIPMENT, (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT                                                                                                                                                                                                                                         
S932500400QUSE THIS CODE WITH S9326, S9327 OR S9328)                                                                                                                                                                                                                                                                            
S932600100PHOME INFUSION THERAPY, CONTINUOUS (TWENTY-FOUR HOURS OR MORE) PAIN MANAGEMENT   HIT cont pain per diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S932600200QINFUSION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S932600300QCOORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS                                                                                                                                                                                                                                      
S932600400QCODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                          
S932700100PHOME INFUSION THERAPY, INTERMITTENT (LESS THAN TWENTY-FOUR HOURS) PAIN          HIT int pain per diem       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S932700200QMANAGEMENT INFUSION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES,                                                                                                                                                                                                                                        
S932700300QCARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                       
S932700400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S932800100PHOME INFUSION THERAPY, IMPLANTED PUMP PAIN MANAGEMENT INFUSION; ADMINISTRATIVE  HIT pain imp pump diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S932800200QSERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S932800300QSUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S932900100PHOME INFUSION THERAPY, CHEMOTHERAPY INFUSION; ADMINISTRATIVE SERVICES,          HIT chemo per diem          00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S932900200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S932900300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT USE                                                                                                                                                                                                                                      
S932900400QTHIS CODE WITH S9330 OR S9331)                                                                                                                                                                                                                                                                                       
S933000100PHOME INFUSION THERAPY, CONTINUOUS (TWENTY-FOUR HOURS OR MORE) CHEMOTHERAPY      HIT cont chem diem          00      9                                                                                                     I                          Z2  9       2002010120020101        N                           
S933000200QINFUSION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S933000300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S933000400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S933100100PHOME INFUSION THERAPY, INTERMITTENT (LESS THAN TWENTY-FOUR HOURS) CHEMOTHERAPY  HIT intermit chemo diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S933100200QINFUSION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S933100300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S933100400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S933500100PHOME THERAPY, HEMODIALYSIS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY      HT hemodialysis diem        00      9                                                                                                     I                          Z2  9       2003070120030701        N                           
S933500200QSERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS                                                                                                                                                                                                                                         
S933500300QAND NURSING SERVICES CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                     
S933600100PHOME INFUSION THERAPY, CONTINUOUS ANTICOAGULANT INFUSION THERAPY (E.G.          HIT cont anticoag diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S933600200QHEPARIN), ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S933600300QCOORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS                                                                                                                                                                                                                                      
S933600400QCODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                          
S933800100PHOME INFUSION THERAPY, IMMUNOTHERAPY, ADMINISTRATIVE SERVICES, PROFESSIONAL     HIT immunotherapy diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S933800200QPHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S933800300Q(DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                
S933900100PHOME THERAPY; PERITONEAL DIALYSIS, ADMINISTRATIVE SERVICES, PROFESSIONAL        HIT periton dialysis diem   00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S933900200QPHARMACY SERVICES, CARE COORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                        
S933900300Q(DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                
S934000100PHOME THERAPY; ENTERAL NUTRITION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY HIT enteral per diem        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S934000200QSERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (ENTERAL                                                                                                                                                                                                                                       
S934000300QFORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                               
S934100100PHOME THERAPY; ENTERAL NUTRITION VIA GRAVITY; ADMINISTRATIVE SERVICES,           HIT enteral grav diem       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S934100200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S934100300QAND EQUIPMENT (ENTERAL FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                        
S934200100PHOME THERAPY; ENTERAL NUTRITION VIA PUMP; ADMINISTRATIVE SERVICES, PROFESSIONAL HIT enteral pump diem       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S934200200QPHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S934200300Q(ENTERAL FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                      
S934300100PHOME THERAPY; ENTERAL NUTRITION VIA BOLUS; ADMINISTRATIVE SERVICES,             HIT enteral bolus nurs      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S934300200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S934300300QAND EQUIPMENT (ENTERAL FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                        
S934500100PHOME INFUSION THERAPY, ANTI-HEMOPHILIC AGENT INFUSION THERAPY (E.G. FACTOR      HIT anti-hemophil diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S934500200QVIII); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                                 
S934500300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S934500400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S934600100PHOME INFUSION THERAPY, ALPHA-1-PROTEINASE INHIBITOR (E.G., PROLASTIN);          HIT alpha-1-proteinas diem  00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S934600200QADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S934600300QALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                 
S934600400QSEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                                
S934700100PHOME INFUSION THERAPY, UNINTERRUPTED, LONG-TERM, CONTROLLED RATE INTRAVENOUS OR HIT longterm infusion diem  00      9                                                                                                     I                      0088Z2  9       2002010120030101        N                           
S934700200QSUBCUTANEOUS INFUSION THERAPY (E.G. EPOPROSTENOL); ADMINISTRATIVE SERVICES,                                                                                                                                                                                                                                          
S934700300QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S934700400QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S934800100PHOME INFUSION THERAPY, SYMPATHOMIMETIC/INOTROPIC AGENT INFUSION THERAPY (E.G.,  HIT sympathomim diem        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S934800200QDOBUTAMINE); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                           
S934800300QCOORDINATION, ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS                                                                                                                                                                                                                                         
S934800400QCODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                          
S934900100PHOME INFUSION THERAPY, TOCOLYTIC INFUSION THERAPY; ADMINISTRATIVE SERVICES,     HIT tocolysis diem          00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S934900200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S934900300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S935100100PHOME INFUSION THERAPY, CONTINUOUS ANTI-EMETIC INFUSION THERAPY; ADMINISTRATIVE  HIT cont antiemetic diem    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S935100200QSERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, ALL NECESSARY                                                                                                                                                                                                                                           
S935100300QSUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S935300100PHOME INFUSION THERAPY, CONTINUOUS INSULIN INFUSION THERAPY; ADMINISTRATIVE      HIT cont insulin diem       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S935300200QSERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S935300300QSUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S935500100PHOME INFUSION THERAPY, CHELATION THERAPY; ADMINISTRATIVE SERVICES, PROFESSIONAL HIT chelation diem          00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S935500200QPHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S935500300Q(DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                
S935700100PHOME INFUSION THERAPY, ENZYME REPLACEMENT INTRAVENOUS THERAPY; (E.G.            HIT enzyme replace diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S935700200QIMIGLUCERASE); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                         
S935700300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S935700400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S935900100PHOME INFUSION THERAPY, ANTI-TUMOR NECROSIS FACTOR INTRAVENOUS THERAPY; (E.G.    HIT anti-tnf per diem       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S935900200QINFLIXIMAB); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                           
S935900300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S935900400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S936100100PHOME INFUSION THERAPY, DIURETIC INTRAVENOUS THERAPY; ADMINISTRATIVE SERVICES,   HIT diuretic infus diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S936100200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S936100300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S936300100PHOME INFUSION THERAPY, ANTI-SPASMOTIC THERAPY; ADMINISTRATIVE SERVICES,         HIT anti-spasmotic diem     00      9                                                                                                     I                      0088Z2  9       2002010120041001        N                           
S936300200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S936300300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S936400100PHOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); ADMINISTRATIVE         HIT tpn total diem          00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S936400200QSERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S936400300QSUPPLIES AND EQUIPMENT INCLUDING STANDARD TPN FORMULA (LIPIDS, SPECIALTY AMINO                                                                                                                                                                                                                                       
S936400400QACID FORMULAS, DRUGS OTHER THAN IN STANDARD FORMULA AND NURSING VISITS CODED                                                                                                                                                                                                                                         
S936400500QSEPARATELY), PER DIEM (DO NOT USE WITH HOME INFUSION CODES S9365-S9368 USING                                                                                                                                                                                                                                         
S936400600QDAILY VOLUME SCALES)                                                                                                                                                                                                                                                                                                 
S936500100PHOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); ONE LITER PER DAY,     HIT tpn 1 liter diem        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S936500200QADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S936500300QALL NECESSARY SUPPLIES AND EQUIPMENT INCLUDING STANDARD TPN FORMULA (LIPIDS,                                                                                                                                                                                                                                         
S936500400QSPECIALTY AMINO ACID FORMULAS, DRUGS OTHER THAN IN STANDARD FORMULA AND NURSING                                                                                                                                                                                                                                      
S936500500QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S936600100PHOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); MORE THAN ONE LITER    HIT tpn 2 liter diem        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S936600200QBUT NO MORE THAN TWO LITERS PER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL                                                                                                                                                                                                                                           
S936600300QPHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S936600400QINCLUDING STANDARD TPN FORMULA (LIPIDS, SPECIALTY AMINO ACID FORMULAS, DRUGS                                                                                                                                                                                                                                         
S936600500QOTHER THAN IN STANDARD FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                        
S936700100PHOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); MORE THAN TWO LITERS   HIT tpn 3 liter diem        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S936700200QBUT NO MORE THAN THREE LITERS PER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL                                                                                                                                                                                                                                         
S936700300QPHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S936700400QINCLUDING STANDARD TPN FORMULA (LIPIDS, SPECIALTY AMINO ACID FORMULAS, DRUGS                                                                                                                                                                                                                                         
S936700500QOTHER THAN IN STANDARD FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                        
S936800100PHOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); MORE THAN THREE LITERS HIT tpn over 3l diem        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S936800200QPER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S936800300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT INCLUDING STANDARD TPN                                                                                                                                                                                                                                        
S936800400QFORMULA (LIPIDS, SPECIALTY AMINO ACID FORMULAS, DRUGS OTHER THAN IN STANDARD                                                                                                                                                                                                                                         
S936800500QFORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                               
S937000100PHOME THERAPY, INTERMITTENT ANTI-EMETIC INJECTION THERAPY; ADMINISTRATIVE        HT inj antiemetic diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S937000200QSERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S937000300QSUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S937200100PHOME THERAPY; INTERMITTENT ANTICOAGULANT INJECTION THERAPY (E.G. HEPARIN);      HT inj anticoag diem        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S937200200QADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S937200300QALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                 
S937200400QSEPARATELY), PER DIEM (DO NOT USE THIS CODE FOR FLUSHING OF INFUSION DEVICES                                                                                                                                                                                                                                         
S937200500QWITH HEPARIN TO MAINTAIN PATENCY)                                                                                                                                                                                                                                                                                    
S937300100PHOME INFUSION THERAPY, HYDRATION THERAPY; ADMINISTRATIVE SERVICES, PROFESSIONAL HIT hydra total diem        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S937300200QPHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S937300300Q(DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT USE WITH                                                                                                                                                                                                                                               
S937300400QHYDRATION THERAPY CODES S9374-S9377 USING DAILY VOLUME SCALES)                                                                                                                                                                                                                                                       
S937400100PHOME INFUSION THERAPY, HYDRATION THERAPY; ONE LITER PER DAY, ADMINISTRATIVE     HIT hydra 1 liter diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S937400200QSERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S937400300QSUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S937500100PHOME INFUSION THERAPY, HYDRATION THERAPY; MORE THAN ONE LITER BUT NO MORE THAN  HIT hydra 2 liter diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S937500200QTWO LITERS PER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES,                                                                                                                                                                                                                                         
S937500300QCARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                       
S937500400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S937600100PHOME INFUSION THERAPY, HYDRATION THERAPY; MORE THAN TWO LITERS BUT NO MORE THAN HIT hydra 3 liter diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S937600200QTHREE LITERS PER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES,                                                                                                                                                                                                                                       
S937600300QCARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                       
S937600400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S937700100PHOME INFUSION THERAPY, HYDRATION THERAPY; MORE THAN THREE LITERS PER DAY,       HIT hydra over 3l diem      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S937700200QADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S937700300QALL NECESSARY SUPPLIES (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S937900100PHOME INFUSION THERAPY, INFUSION THERAPY, NOT OTHERWISE CLASSIFIED;              HIT noc per diem            00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S937900200QADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S937900300QALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                 
S937900400QSEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                                
S938100100PDELIVERY OR SERVICE TO HIGH RISK AREAS REQUIRING ESCORT OR EXTRA PROTECTION,    HIT high risk/escort        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S938100200QPER VISIT                                                                                                                                                                                                                                                                                                            
S940100100PANTICOAGULATION CLINIC, INCLUSIVE OF ALL SERVICES EXCEPT LABORATORY TESTS, PER  Anticoag clinic per session 00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S940100200QSESSION                                                                                                                                                                                                                                                                                                              
S943000100PPHARMACY COMPOUNDING AND DISPENSING SERVICES                                    Pharmacy comp/disp serv     00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S943400100PMODIFIED SOLID FOOD SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM                 Mod solid food suppl        00      9                                                                                                     I                          Z2  9       2003040120030401        N                           
S943500100PMEDICAL FOODS FOR INBORN ERRORS OF METABOLISM                                   Medical foods for inborn err00      9                                                                                                     I                      0088Z2  9       2001010120010101        N                           
S943600100PCHILDBIRTH PREPARATION/LAMAZE CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION      Lamaze class                00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S943700100PCHILDBIRTH REFRESHER CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION               Childbirth refresher class  00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S943800100PCESAREAN BIRTH CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                     Cesarean birth class        00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S943900100PVBAC (VAGINAL BIRTH AFTER CESAREAN) CLASSES, NON-PHYSICIAN PROVIDER, PER SESSIONVBAC class                  00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S944100100PASTHMA EDUCATION, NON-PHYSICIAN PROVIDER, PER SESSION                           Asthma education            00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S944200100PBIRTHING CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                           Birthing class              00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S944300100PLACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                          Lactation class             00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S944400100PPARENTING CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                          Parenting class             00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S944500100PPATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER,            PT education noc individ    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S944500200QINDIVIDUAL, PER SESSION                                                                                                                                                                                                                                                                                              
S944600100PPATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, GROUP, PER PT education noc group      00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S944600200QSESSION                                                                                                                                                                                                                                                                                                              
S944700100PINFANT SAFETY (INCLUDING CPR) CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION      Infant safety class         00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S944900100PWEIGHT MANAGEMENT CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                  Weight mgmt class           00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S945100100PEXERCISE CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                           Exercise class              00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S945200100PNUTRITION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                          Nutrition class             00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S945300100PSMOKING CESSATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                  Smoking cessation class     00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S945400100PSTRESS MANAGEMENT CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                  Stress mgmt class           00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S945500100PDIABETIC MANAGEMENT PROGRAM, GROUP SESSION                                      Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S946000100PDIABETIC MANAGEMENT PROGRAM, NURSE VISIT                                        Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S946500100PDIABETIC MANAGEMENT PROGRAM, DIETITIAN VISIT                                    Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S947000100PNUTRITIONAL COUNSELING, DIETITIAN VISIT                                         Nutritional counseling, diet00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S947200100PCARDIAC REHABILITATION PROGRAM, NON-PHYSICIAN PROVIDER, PER DIEM                Cardiac rehabilitation progr00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S947300100PPULMONARY REHABILITATION PROGRAM, NON-PHYSICIAN PROVIDER, PER DIEM              Pulmonary rehabilitation pro00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S947400100PENTEROSTOMAL THERAPY BY A REGISTERED NURSE CERTIFIED IN ENTEROSTOMAL THERAPY,   Enterostomal therapy by a re00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S947400200QPER DIEM                                                                                                                                                                                                                                                                                                             
S947500100PAMBULATORY SETTING SUBSTANCE ABUSE TREATMENT OR DETOXIFICATION SERVICES, PER    Ambulatory setting substance00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S947500200QDIEM                                                                                                                                                                                                                                                                                                                 
S947600100PVESTIBULAR REHABILITATION PROGRAM, NON-PHYSICIAN PROVIDER, PER DIEM             Vestibular rehab per diem   00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
S948000100PINTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM                             Intensive outpatient psychia00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S948200100PFAMILY STABILIZATION SERVICES, PER 15 MINUTES                                   Family stabilization 15 min 00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
S948400100PCRISIS INTERVENTION MENTAL HEALTH SERVICES, PER HOUR                            Crisis intervention per hour00      9                                                                                                     I                          Z2  9       2002070120020701        N                           
S948500100PCRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM                            Crisis intervention mental h00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S949000100PHOME INFUSION THERAPY, CORTICOSTEROID INFUSION; ADMINISTRATIVE SERVICES,        HIT corticosteroid/diem     00      9                                                                                                     I                          Z2  9       2002070120020701        N                           
S949000200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S949000300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S949400100PHOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY;            HIT antibiotic total diem   00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S949400200QADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S949400300QALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                 
S949400400QSEPARATELY, PER DIEM) (DO NOT USE THIS CODE WITH HOME INFUSION CODES FOR HOURLY                                                                                                                                                                                                                                      
S949400500QDOSING SCHEDULES S9497-S9504)                                                                                                                                                                                                                                                                                        
S949700100PHOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY HIT antibiotic q3h diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S949700200Q3 HOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S949700300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S949700400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S950000100PHOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY HIT antibiotic q24h diem    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S950000200Q24 HOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S950000300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S950000400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S950100100PHOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY HIT antibiotic q12h diem    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S950100200Q12 HOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S950100300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S950100400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S950200100PHOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY HIT antibiotic q8h diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S950200200Q8 HOURS, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S950200300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S950200400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S950300100PHOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL; ONCE EVERY 6       HIT antibiotic q6h diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S950300200QHOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                                 
S950300300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S950300400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S950400100PHOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL; ONCE EVERY 4       HIT antibiotic q4h diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S950400200QHOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                                 
S950400300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S950400400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S952400100PNURSING SERVICES RELATED TO HOME IV THERAPY, PER DIEM                           Nursing services related to 00      9                                                                                                     I                      0088Z2  9       200001012003040120030331N                           
S952900100PROUTINE VENIPUNCTURE FOR COLLECTION OF SPECIMEN(S), SINGLE HOME BOUND, NURSING  Venipuncture home/snf       00      9                                                                                                     I                      0088Z2  5       2002010120020101        N                           
S952900200QHOME, OR SKILLED NURSING FACILITY PATIENT                                                                                                                                                                                                                                                                            
S953700100PHOME THERAPY; HEMATOPOIETIC HORMONE INJECTION THERAPY (E.G.ERYTHROPOIETIN,      HT hem horm inj diem        00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S953700200QG-CSF, GM-CSF); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                        
S953700300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S953700400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S953800100PHOME TRANSFUSION OF BLOOD PRODUCT(S); ADMINISTRATIVE SERVICES, PROFESSIONAL     HIT blood products diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S953800200QPHARMACY SERVICES, CARE COORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                        
S953800300Q(BLOOD PRODUCTS, DRUGS, AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                               
S954200100PHOME INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED, INCLUDING ADMINISTRATIVE     HT inj noc per diem         00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S954200200QSERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S954200300QSUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S954300100PADMINISTRATION OF MEDICATION, INTRAMUSCULARLY, EPIDURALLY OR SUBCUTANEOUSLY, IN Administration of medication00      9                                                                                                     I                      0088Z2  9       200001012002040120020331N                           
S954300200QTHE HOME SETTING, INCLUDING ALL NURSING CARE, EQUIPMENT, AND SUPPLIES; PER DIEM                                                                                                                                                                                                                                      
S954600100PHOME INFUSION OF BLOOD PRODUCTS, NURSING SERVICES, PER VISIT                    Home inf blood prod nurs ser00      9                                                                                                     I                          Z2  9       200204012003100120030930N                           
S955800100PHOME INJECTABLE THERAPY; GROWTH HORMONE, INCLUDING ADMINISTRATIVE SERVICES,     HT inj growth horm diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S955800200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S955800300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S955900100PHOME INJECTABLE THERAPY, INTERFERON, INCLUDING ADMINISTRATIVE SERVICES,         HIT inj interferon diem     00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S955900200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S955900300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S956000100PHOME INJECTABLE THERAPY; HORMONAL THERAPY (E.G.; LEUPROLIDE, GOSERELIN),        HT inj hormone diem         00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S956000200QINCLUDING ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S956000300QCOORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S956000400QVISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S956200100PHOME INJECTABLE THERAPY, PALIVIZUMAB, INCLUDING ADMINISTRATIVE SERVICES,        HT inj palivizumab diem     00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S956200200QPROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S956200300QAND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S959000100PHOME THERAPY, IRRIGATION THERAPY (E.G. STERILE IRRIGATION OF AN ORGAN OR        HT irrigation diem          00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
S959000200QANATOMICAL CAVITY); INCLUDING ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY                                                                                                                                                                                                                                         
S959000300QSERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS                                                                                                                                                                                                                                         
S959000400QAND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                       
S980000100PHOME THERAPY; PROVISION OF INFUSION, SPECIALTY DRUG ADMINISTRATION, AND/OR      HT rn per hour              00      9                                                                            S9802S9803               I                      0088Z2  1       200201012003010120021231N                           
S980000200QASSOCIATED NURSING SERVICES AND PROCEDURES, BY HIGHLY TECHNICAL R.N., PER HOUR                                                                                                                                                                                                                                       
S980000300Q(DO NOT USE THIS CODE WITH S9524)                                                                                                                                                                                                                                                                                    
S980200100PHOME INFUSION/SPECIALTY DRUG ADMINISTRATION, NURSING SERVICES; PER VISIT (UP TO HT nursing visit            00      9                                                                                                     I                          Z2  9       200301012003070120030630N                           
S980200200Q2 HOURS)                                                                                                                                                                                                                                                                                                             
S980300100PHOME INFUSION/SPECIALTY DRUG ADMINISTRATION, NURSING SERVICES; EACH ADDITIONAL  HT nursing addl hr          00      9                                                                                                     I                          Z2  9       200301012003070120030630N                           
S980300200QHOUR (LIST SEPARATELY IN ADDITION TO CODE S9802)                                                                                                                                                                                                                                                                     
S980600100PRN SERVICES IN THE INFUSION SUITE OF THE IV THERAPY PROVIDER, PER VISIT         RN infusion suite visit     00      9                                                                                                     I                          Z2  9       200207012004010120031231N                           
S981000100PHOME THERAPY; PROFESSIONAL PHARMACY SERVICES FOR PROVISION OF INFUSION,         HT pharm per hour           00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S981000200QSPECIALTY DRUG ADMINISTRATION, AND/OR DISEASE STATE MANAGEMENT, NOT OTHERWISE                                                                                                                                                                                                                                        
S981000300QCLASSIFIED, PER HOUR (DO NOT USE THIS CODE WITH ANY PER DIEM CODE)                                                                                                                                                                                                                                                   
S990000100PSERVICES BY AUTHORIZED CHRISTIAN SCIENCE PRACTITIONER FOR THE PROCESS OF        Christian Sci Pract visit   00      9                                                                                                     I                          Z2  9       2002070120020701        N                           
S990000200QHEALING, PER DIEM; NOT TO BE USED FOR REST OR STUDY; EXCLUDES IN-PATIENT                                                                                                                                                                                                                                             
S990000300QSERVICES                                                                                                                                                                                                                                                                                                             
S997000100PHEALTH CLUB MEMBERSHIP, ANNUAL                                                  Health club membership yr   00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S997500100PTRANSPLANT RELATED LODGING, MEALS AND TRANSPORTATION, PER DIEM                  Transplant related per diem 00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
S997600100PLODGING, PER DIEM, NOT OTHERWISE CLASSIFIED                                     Lodging per diem            00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S997700100PMEALS, PER DIEM, NOT OTHERWISE SPECIFIED                                        Meals per diem              00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S998100100PMEDICAL RECORDS COPYING FEE, ADMINISTRATIVE                                     Med record copy admin       00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S998200100PMEDICAL RECORDS COPYING FEE, PER PAGE                                           Med record copy per page    00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S998600100PNOT MEDICALLY NECESSARY SERVICE (PATIENT IS AWARE THAT SERVICE NOT MEDICALLY    Not medically necessary svc 00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S998600200QNECESSARY)                                                                                                                                                                                                                                                                                                           
S998800100PSERVICES PROVIDED AS PART OF A PHASE I CLINICAL TRIAL                           Serv part of phase I trial  00      9                                                                                                     I                          Z2  9       2004040120040401        N                           
S998900100PSERVICES PROVIDED OUTSIDE OF THE UNITED STATES OF AMERICA (LIST IN ADDITION TO  Services outside US         00      9                                                                                                     I                      0088Z2  9       2002010120020101        N                           
S998900200QCODE(S) FOR SERVICES(S))                                                                                                                                                                                                                                                                                             
S999000100PSERVICES PROVIDED AS PART OF A PHASE II CLINICAL TRIAL                          Services provided as part of00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S999100100PSERVICES PROVIDED AS PART OF A PHASE III CLINICAL TRIAL                         Services provided as part of00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S999200100PTRANSPORTATION COSTS TO AND FROM TRIAL LOCATION AND LOCAL TRANSPORTATION COSTS  Transportation costs to and 00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S999200200Q(E.G., FARES FOR TAXICAB OR BUS) FOR CLINICAL TRIAL PARTICIPANT AND ONE                                                                                                                                                                                                                                              
S999200300QCAREGIVER/COMPANION                                                                                                                                                                                                                                                                                                  
S999400100PLODGING COSTS (E.G., HOTEL CHARGES) FOR CLINICAL TRIAL PARTICIPANT AND ONE      Lodging costs (e.g. hotel ch00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S999400200QCAREGIVER/COMPANION                                                                                                                                                                                                                                                                                                  
S999600100PMEALS FOR CLINICAL TRIAL PARTICIPANT AND ONE CAREGIVER/COMPANION                Meals for clinical trial par00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
S999900100PSALES TAX                                                                       Sales tax                   00      9                                                                                                     I                      0088Z2  9       2000010120000101        N                           
T100000100PPRIVATE DUTY / INDEPENDENT NURSING SERVICE(S) - LICENSED, UP TO 15 MINUTES      Private duty/independent nsg00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T100100100PNURSING ASSESSMENT / EVALUATION                                                 Nursing assessment/evaluatn 00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T100200100PRN SERVICES, UP TO 15 MINUTES                                                   RN services up to 15 minutes00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T100300100PLPN/LVN SERVICES, UP TO 15 MINUTES                                              LPN/LVN services up to 15min00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T100400100PSERVICES OF A QUALIFIED NURSING AIDE, UP TO 15 MINUTES                          Nsg aide service up to 15min00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T100500100PRESPITE CARE SERVICES, UP TO 15 MINUTES                                         Respite care service 15 min 00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T100600100PALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, FAMILY/COUPLE COUNSELING               Family/Couple Counseling    00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T100700100PALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, TREATMENT PLAN DEVELOPMENT AND/OR      Treatment Plan Development  00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T100700200QMODIFICATION                                                                                                                                                                                                                                                                                                         
T100800100PDAY TREATMENT FOR  INDIVIDUAL ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES           Day Treatment for Individual00      9                                                                                                     I                          Z2  9       200107012003040120030331N                           
T100900100PCHILD SITTING SERVICES FOR CHILDREN OF THE INDIVIDUAL RECEIVING ALCOHOL AND/OR  Child Sitting Services      00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T100900200QSUBSTANCE ABUSE SERVICES                                                                                                                                                                                                                                                                                             
T101000100PMEALS FOR INDIVIDUALS RECEIVING ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES (WHEN   Meals when Receive Services 00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T101000200QMEALS NOT INCLUDED IN THE PROGRAM)                                                                                                                                                                                                                                                                                   
T101100100PALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, NOT OTHERWISE CLASSIFIED               Alcohol/Substance Abuse NOC 00      9                                                                                                     I                          Z2  9       200107012003040120030331N                           
T101200100PALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, SKILLS DEVELOPMENT                     Alcohol/Substance Abuse Skil00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T101300100PSIGN LANGUAGE OR ORAL INTERPRETIVE SERVICES, PER 15 MINUTES                     Sign Lang/Oral Interpreter  00      9                                                                                                     I                          Z2  9       2001070120030101        N                           
T101400100PTELEHEALTH TRANSMISSION, PER MINUTE, PROFESSIONAL SERVICES BILL SEPARATELY      Telehealth transmit, per min00      9                                                                                                     I                          Z2  9       2001070120010701        N                           
T101500100PCLINIC VISIT/ENCOUNTER, ALL-INCLUSIVE                                           Clinic service              00      9                                                                                                     I                          Z2  1       2002010120020101        N                           
T101600100PCASE MANAGEMENT, EACH 15 MINUTES                                                Case management             00      9                                                                                                     I                          Z2  9       2002070120020701        N                           
T101700100PTARGETED CASE MANAGEMENT, EACH 15 MINUTES                                       Targeted case management    00      9                                                                                                     I                          Z2  9       2002070120020701        N                           
T101800100PSCHOOL-BASED INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES, BUNDLED           School-based IEP ser bundled00      9                                                                                                     I                          Z2  9       2002070120020701        N                           
T101900100PPERSONAL CARE SERVICES, PER 15 MINUTES, NOT FOR AN INPATIENT OR RESIDENT OF A   Personal care ser per 15 min00      9                                                                                                     I                          Z2  9       2002070120020701        N                           
T101900200QHOSPITAL, NURSING FACILITY, ICF/MR OR IMD, PART OF THE INDIVIDUALIZED PLAN OF                                                                                                                                                                                                                                        
T101900300QTREATMENT (CODE MAY NOT BE USED TO IDENTIFY SERVICES PROVIDED BY HOME HEALTH                                                                                                                                                                                                                                         
T101900400QAIDE OR CERTIFIED NURSE ASSISTANT)                                                                                                                                                                                                                                                                                   
T102000100PPERSONAL CARE SERVICES, PER DIEM, NOT FOR AN INPATIENT OR RESIDENT OF A         Personal care ser per diem  00      9                                                                                                     I                          Z2  9       2002070120020701        N                           
T102000200QHOSPITAL, NURSING FACILITY, ICF/MR OR IMD, PART OF THE INDIVIDUALIZED PLAN OF                                                                                                                                                                                                                                        
T102000300QTREATMENT (CODE MAY NOT BE USED TO IDENTIFY SERVICES PROVIDED BY HOME HEALTH                                                                                                                                                                                                                                         
T102000400QAIDE OR CERTIFIED NURSE ASSISTANT)                                                                                                                                                                                                                                                                                   
T102100100PHOME HEALTH AIDE OR CERTIFIED NURSE ASSISTANT, PER VISIT                        HH Aide or cn aide per visit00      9                                                                                                     I                          Z2  9       2002070120020701        N                           
T102200100PCONTRACTED HOME HEALTH AGENCY SERVICES, ALL SERVICES PROVIDED UNDER CONTRACT,   Contracted services per day 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T102200200QPER DAY                                                                                                                                                                                                                                                                                                              
T102300100PSCREENING TO DETERMINE THE APPROPRIATENESS OF CONSIDERATION OF AN INDIVIDUAL    Program intake assessment   00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T102300200QFOR PARTICIPATION IN A SPECIFIED PROGRAM, PROJECT OR TREATMENT PROTOCOL, PER                                                                                                                                                                                                                                         
T102300300QENCOUNTER                                                                                                                                                                                                                                                                                                            
T102400100PEVALUATION AND TREATMENT BY AN INTEGRATED, SPECIALTY TEAM CONTRACTED TO PROVIDE Team evaluation & management00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T102400200QCOORDINATED CARE TO MULTIPLE OR SEVERELY HANDICAPPED CHILDREN, PER ENCOUNTER                                                                                                                                                                                                                                         
T102500100PINTENSIVE, EXTENDED MULTIDISCIPLINARY SERVICES PROVIDED IN A CLINIC SETTING TO  Ped compr care pkg, per diem00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T102500200QCHILDREN WITH COMPLEX MEDICAL, PHYSICAL, MENTAL AND PSYCHOSOCIAL IMPAIRMENTS,                                                                                                                                                                                                                                        
T102500300QPER DIEM                                                                                                                                                                                                                                                                                                             
T102600100PINTENSIVE, EXTENDED MULTIDISCIPLINARY SERVICES PROVIDED IN A CLINIC SETTING TO  Ped compr care pkg, per hour00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T102600200QCHILDREN WITH COMPLEX MEDICAL, PHYSICAL, MEDICAL AND PSYCHOSOCIAL IMPAIRMENTS,                                                                                                                                                                                                                                       
T102600300QPER HOUR                                                                                                                                                                                                                                                                                                             
T102700100PFAMILY TRAINING AND COUNSELING FOR CHILD DEVELOPMENT, PER 15 MINUTES            Family training & counseling00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T102800100PASSESSMENT OF HOME, PHYSICAL AND FAMILY ENVIRONMENT, TO DETERMINE SUITABILITY   Home environment assessment 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T102800200QTO MEET PATIENT'S MEDICAL NEEDS                                                                                                                                                                                                                                                                                      
T102900100PCOMPREHENSIVE ENVIRONMENTAL LEAD INVESTIGATION, NOT INCLUDING LABORATORY        Dwelling lead investigation 00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T102900200QANALYSIS, PER DWELLING                                                                                                                                                                                                                                                                                               
T103000100PNURSING CARE, IN THE HOME, BY REGISTERED NURSE, PER DIEM                        RN home care per diem       00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T103100100PNURSING CARE, IN THE HOME, BY LICENSED PRACTICAL NURSE, PER DIEM                LPN home care per diem      00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T150000100PDIAPER/INCONTINENT PANT, REUSABLE/WASHABLE, ANY SIZE, EACH                      Reusable diaper/pant        00      9                                                                                                     I                          Z2  9       200301012005010120041231N                           
T150200100PADMINISTRATION OF ORAL, INTRAMUSCULAR AND/OR SUBCUTANEOUS MEDICATION BY HEALTH  Medication admin visit      00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T150200200QCARE AGENCY/PROFESSIONAL, PER VISIT                                                                                                                                                                                                                                                                                  
T199900100PMISCELLANEOUS THERAPEUTIC ITEMS AND SUPPLIES, RETAIL PURCHASES, NOT OTHERWISE   NOC retail items andsupplies00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T199900200QCLASSIFIED; IDENTIFY PRODUCT IN "REMARKS"                                                                                                                                                                                                                                                                            
T200100100PNON-EMERGENCY TRANSPORTATION; PATIENT ATTENDANT/ESCORT                          N-et; patient attend/escort 00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
T200200100PNON-EMERGENCY TRANSPORTATION; PER DIEM                                          N-et; per diem              00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
T200300100PNON-EMERGENCY TRANSPORTATION; ENCOUNTER/TRIP                                    N-et; encounter/trip        00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
T200400100PNON-EMERGENCY TRANSPORT; COMMERCIAL CARRIER, MULTI-PASS                         N-et; commerc carrier pass  00      9                                                                                                     I                          Z2  9       2002040120020401        N                           
T200500100PNON-EMERGENCY TRANSPORTATION; STRETCHER VAN                                     N-et; stretcher van         00      9                                                                                                     I                          Z2  9       2002040120040701        N                           
T200600100PAMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT                                  Amb response & trt, no trans00      9                                                                            A0998                    I                          Z2  9       200204012006010120051231D                           
T200700100PTRANSPORTATION WAITING TIME, AIR AMBULANCE AND NON-EMERGENCY VEHICLE, ONE-HALF  Non-emer transport wait time00      9                                                                                                     I                          Z2  9       2003010120030101        N                           
T200700200Q(1/2) HOUR INCREMENTS                                                                                                                                                                                                                                                                                                
T201000100PPREADMISSION SCREENING AND RESIDENT REVIEW (PASRR) LEVEL I IDENTIFICATION       PASRR Level I               00      9                                                                                                     I                      0112Z2  9       2003040120030401        N                           
T201000200QSCREENING, PER SCREEN                                                                                                                                                                                                                                                                                                
T201100100PPREADMISSION SCREENING AND RESIDENT REVIEW (PASRR) LEVEL II EVALUATION, PER     PASRR Level II              00      9                                                                                                     I                      0113Z2  9       2003040120030401        N                           
T201100200QEVALUATION                                                                                                                                                                                                                                                                                                           
T201200100PHABILITATION, EDUCATIONAL; WAIVER, PER DIEM                                     Habil ed waiver, per diem   00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T201300100PHABILITATION, EDUCATIONAL, WAIVER; PER HOUR                                     Habil ed waiver per hour    00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T201400100PHABILITATION, PREVOCATIONAL, WAIVER; PER DIEM                                   Habil prevoc waiver, per d  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T201500100PHABILITATION, PREVOCATIONAL, WAIVER; PER HOUR                                   Habil prevoc waiver per hr  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T201600100PHABILITATION, RESIDENTIAL, WAIVER; PER DIEM                                     Habil res waiver per diem   00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T201700100PHABILITATION, RESIDENTIAL, WAIVER; 15 MINUTES                                   Habil res waiver 15 min     00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T201800100PHABILITATION, SUPPORTED EMPLOYMENT, WAIVER; PER DIEM                            Habil sup empl waiver/diem  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T201900100PHABILITATION, SUPPORTED EMPLOYMENT, WAIVER; PER 15 MINUTES                      Habil sup empl waiver 15min 00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202000100PDAY HABILITATION, WAIVER; PER DIEM                                              Day habil waiver per diem   00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202100100PDAY HABILITATION, WAIVER; PER 15 MINUTES                                        Day habil waiver per 15 min 00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202200100PCASE MANAGEMENT, PER MONTH                                                      Case management, per month  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202300100PTARGETED CASE MANAGEMENT; PER MONTH                                             Targeted case mgmt per month00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202400100PSERVICE ASSESSMENT/PLAN OF CARE DEVELOPMENT, WAIVER                             Serv asmnt/care plan waiver 00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202500100PWAIVER SERVICES; NOT OTHERWISE SPECIFIED (NOS)                                  Waiver service, nos         00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202600100PSPECIALIZED CHILDCARE, WAIVER; PER DIEM                                         Special childcare waiver/d  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202700100PSPECIALIZED CHILDCARE, WAIVER; PER 15 MINUTES                                   Spec childcare waiver 15 min00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202800100PSPECIALIZED SUPPLY, NOT OTHERWISE SPECIFIED, WAIVER                             Special supply, nos waiver  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T202900100PSPECIALIZED MEDICAL EQUIPMENT, NOT OTHERWISE SPECIFIED, WAIVER                  Special med equip, noswaiver00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203000100PASSISTED LIVING, WAIVER; PER MONTH                                              Assist living waiver/month  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203100100PASSISTED LIVING; WAIVER, PER DIEM                                               Assist living waiver/diem   00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203200100PRESIDENTIAL CARE, NOT OTHERWISE SPECIFIED (NOS), WAIVER; PER MONTH              Res care, nos waiver/month  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203300100PRESIDENTIAL CARE, NOT OTHERWISE SPECIFIED (NOS), WAIVER; PER DIEM               Res, nos waiver per diem    00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203400100PCRISIS INTERVENTION, WAIVER; PER DIEM                                           Crisis interven waiver/diem 00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203500100PUTILITY SERVICES TO SUPPORT MEDICAL EQUIPMENT AND ASSISTIVE TECHNOLOGY/DEVICES, Utility services waiver     00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203500200QWAIVER                                                                                                                                                                                                                                                                                                               
T203600100PTHERAPEUTIC CAMPING, OVERNIGHT, WAIVER; EACH SESSION                            Camp overnite waiver/session00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203700100PTHERAPEUTIC CAMPING, DAY, WAIVER; EACH SESSION                                  Camp day waiver/session     00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203800100PCOMMUNITY TRANSITION, WAIVER; PER SERVICE                                       Comm trans waiver/service   00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T203900100PVEHICLE MODIFICATIONS, WAIVER; PER SERVICE                                      Vehicle mod waiver/service  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T204000100PFINANCIAL MANAGEMENT, SELF-DIRECTED, WAIVER; PER 15 MINUTES                     Financial mgt waiver/15min  00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T204100100PSUPPORTS BROKERAGE, SELF-DIRECTED, WAIVER; PER 15 MINUTES                       Support broker waiver/15 min00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T204200100PHOSPICE ROUTINE HOME CARE; PER DIEM                                             Hospice routine home care   00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T204300100PHOSPICE CONTINUOUS HOME CARE; PER HOUR                                          Hospice continuous home care00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T204400100PHOSPICE INPATIENT RESPITE CARE; PER DIEM                                        Hospice respite care        00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T204500100PHOSPICE GENERAL INPATIENT CARE; PER DIEM                                        Hospice general care        00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T204600100PHOSPICE LONG TERM CARE, ROOM AND BOARD ONLY; PER DIEM                           Hospice long term care, r&b 00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T204800100PBEHAVIORAL HEALTH; LONG-TERM CARE RESIDENTIAL (NON-ACUTE CARE IN A RESIDENTIAL  Bh ltc res r&b, per diem    00      9                                                                                                     I                          Z2  9       2003100120031001        N                           
T204800200QTREATMENT PROGRAM WHERE STAY IS TYPICALLY LONGER THAN 30 DAYS), WITH ROOM AND                                                                                                                                                                                                                                        
T204800300QBOARD, PER DIEM                                                                                                                                                                                                                                                                                                      
T204900100PNON-EMERGENCY TRANSPORTATION; STRETCHER VAN, MILEAGE; PER MILE                  N-ET; stretcher van, mileage00      9                                                                                                     I                          Z2  9       2004070120040701        N                           
T210100100PHUMAN BREAST MILK PROCESSING, STORAGE AND DISTRIBUTION ONLY                     Breast milk proc/store/dist 00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
T452100100PADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, SMALL, EACH          Adult size brief/diaper sm  00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T452200100PADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, MEDIUM, EACH         Adult size brief/diaper med 00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T452300100PADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, LARGE, EACH          Adult size brief/diaper lg  00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T452400100PADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, EXTRA LARGE, EACH    Adult size brief/diaper xl  00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T452500100PADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,      Adult size pull-on sm       00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T452500200QSMALL SIZE, EACH                                                                                                                                                                                                                                                                                                     
T452600100PADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,      Adult size pull-on med      00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T452600200QMEDIUM SIZE, EACH                                                                                                                                                                                                                                                                                                    
T452700100PADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,      Adult size pull-on lg       00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T452700200QLARGE SIZE, EACH                                                                                                                                                                                                                                                                                                     
T452800100PADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,      Adult size pull-on xl       00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T452800200QEXTRA LARGE SIZE, EACH                                                                                                                                                                                                                                                                                               
T452900100PPEDIATRIC SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, SMALL/MEDIUM     Ped size brief/diaper sm/med00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T452900200QSIZE, EACH                                                                                                                                                                                                                                                                                                           
T453000100PPEDIATRIC SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, LARGE SIZE, EACH Ped size brief/diaper lg    00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T453100100PPEDIATRIC SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE  UNDERWEAR/PULL-ON, Ped size pull-on sm/med     00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T453100200QSMALL/MEDIUM SIZE, EACH                                                                                                                                                                                                                                                                                              
T453200100PPEDIATRIC SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,  Ped size pull-on lg         00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T453200200QLARGE SIZE, EACH                                                                                                                                                                                                                                                                                                     
T453300100PYOUTH SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, EACH                 Youth size brief/diaper     00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T453400100PYOUTH SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON, EACH Youth size pull-on          00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T453500100PDISPOSABLE LINER/SHIELD/GUARD/PAD/UNDERGARMENT, FOR INCONTINENCE, EACH          Disposable liner/shield/pad 00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T453600100PINCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON, REUSABLE, ANY SIZE, EACH    Reusable pull-on any size   00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T453700100PINCONTINENCE PRODUCT, PROTECTIVE UNDERPAD, REUSABLE, BED SIZE, EACH             Reusable underpad bed size  00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T453800100PDIAPER SERVICE, REUSABLE DIAPER, EACH DIAPER                                    Diaper serv reusable diaper 00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T453900100PINCONTINENCE PRODUCT, DIAPER/BRIEF, REUSABLE, ANY SIZE, EACH                    Reuse diaper/brief any size 00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T454000100PINCONTINENCE PRODUCT, PROTECTIVE UNDERPAD, REUSABLE, CHAIR SIZE, EACH           Reusable underpad chair size00      960-9                                                                                                 M                          D1A 9       2005010120050101        N                           
T454100100PINCONTINENCE PRODUCT, DISPOSABLE UNDERPAD, LARGE, EACH                          Large disposable underpad   00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
T454200100PINCONTINENCE PRODUCT, DISPOSABLE UNDERPAD, SMALL SIZE, EACH                     Small disposable underpad   00      9                                                                                                     I                          Z2  9       2005010120050101        N                           
T500100100PPOSITIONING SEAT FOR PERSONS WITH SPECIAL ORTHOPEDIC NEEDS, FOR USE IN VEHICLES Special position seat/vehicl00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
T599900100PSUPPLY, NOT OTHERWISE SPECIFIED                                                 Supply, nos                 00      9                                                                                                     I                          Z2  9       2004010120040101        N                           
V202000100PFRAMES, PURCHASES                                                               Vision svcs frames purchases38      A                  2130                                                                               D                          D1F Q       1985010120031001        N                           
V202500100PDELUXE FRAME                                                                    Eyeglasses delux frames     00      9                  3045.4                                                                             M                          D1F Q       1992010120031001        N                           
V210000100PSPHERE, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00, PER LENS                    Lens spher single plano 4.0038      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210100100PSPHERE, SINGLE VISION, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS      Single visn sphere 4.12-7.0038      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210200100PSPHERE, SINGLE VISION, PLUS OR MINUS  7.12 TO PLUS OR MINUS 20.00D, PER LENS    Singl visn sphere 7.12-20.0038      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210300100PSPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO      Spherocylindr 4.00d/12-2.00d38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210300200Q2.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                             
V210400100PSPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO     Spherocylindr 4.00d/2.12-4d 38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210400200Q4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                             
V210500100PSPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO     Spherocylinder 4.00d/4.25-6d38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210500200Q6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                             
V210600100PSPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D  Spherocylinder 4.00d/>6.00d 38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210600200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V210700100PSPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00 SPHERE, Spherocylinder 4.25d/12-2d  38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210700200Q.12 TO 2.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                      
V210800100PSPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D       Spherocylinder 4.25d/2.12-4d38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210800200QSPHERE, 2.12 TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                             
V210900100PSPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D        Spherocylinder 4.25d/4.25-6d38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V210900200QSPHERE, 4.25 TO 6.00D  CYLINDER, PER LENS                                                                                                                                                                                                                                                                            
V211000100PSPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO 7.00D SPHERE, OVER 6.00D   Spherocylinder 4.25d/over 6d38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V211000200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V211100100PSPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D       Spherocylindr 7.25d/.25-2.2538      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V211100200QSPHERE, .25 TO 2.25D CYLINDER, PER LENS                                                                                                                                                                                                                                                                              
V211200100PSPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D       Spherocylindr 7.25d/2.25-4d 38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V211200200QSPHERE, 2.25D TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                            
V211300100PSPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D       Spherocylindr 7.25d/4.25-6d 38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V211300200QSPHERE, 4.25 TO 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                             
V211400100PSPHEROCYLINDER, SINGLE VISION, SPHERE OVER PLUS OR MINUS 12.00D, PER LENS       Spherocylinder over 12.00d  38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V211500100PLENTICULAR, (MYODISC), PER LENS, SINGLE VISION                                  Lens lenticular bifocal     38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V211600100PLENTICULAR LENS, NONASPHERIC, PER LENS, SINGLE VISION                           Nonaspheric lens bifocal    38      A                                                                                                     C                          D1F Q       198501012004010120031231N                           
V211700100PLENTICULAR, ASPHERIC, PER LENS, SINGLE VISION                                   Aspheric lens bifocal       38      A                                                                                                     C                          D1F Q       198501012004010120031231N                           
V211800100PANISEIKONIC LENS, SINGLE VISION                                                 Lens aniseikonic single     38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V212100100PLENTICULAR LENS, PER LENS, SINGLE                                               Lenticular lens, single     38      A                  2130.B                                                                             D                          D1F Q       2004010120040101        N                           
V219900100PNOT OTHERWISE CLASSIFIED, SINGLE VISION LENS                                    Lens single vision not oth c46      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220000100PSPHERE, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS                         Lens spher bifoc plano 4.00d38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220100100PSPHERE, BIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS            Lens sphere bifocal 4.12-7.038      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220200100PSPHERE, BIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS           Lens sphere bifocal 7.12-20.38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220300100PSPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO 2.00D      Lens sphcyl bifocal 4.00d/.138      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220300200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V220400100PSPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO 4.00D     Lens sphcy bifocal 4.00d/2.138      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220400200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V220500100PSPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D     Lens sphcy bifocal 4.00d/4.238      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220500200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V220600100PSPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D        Lens sphcy bifocal 4.00d/ove38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220600200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V220700100PSPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,.12   Lens sphcy bifocal 4.25-7d/.38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220700200QTO 2.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                          
V220800100PSPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 2.12 Lens sphcy bifocal 4.25-7/2.38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220800200QTO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                          
V220900100PSPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 4.25 Lens sphcy bifocal 4.25-7/4.38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V220900200QTO  6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                         
V221000100PSPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, OVER Lens sphcy bifocal 4.25-7/ov38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V221000200Q6.00D CYLINDER,PER LENS                                                                                                                                                                                                                                                                                              
V221100100PSPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, .25 Lens sphcy bifo 7.25-12/.25-38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V221100200QTO 2.25D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                          
V221200100PSPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,     Lens sphcyl bifo 7.25-12/2.238      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V221200200Q2.25 TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V221300100PSPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,     Lens sphcyl bifo 7.25-12/4.238      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V221300200Q4.25 TO 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V221400100PSPHEROCYLINDER, BIFOCAL, SPHERE OVER PLUS OR MINUS 12.00D, PER LENS             Lens sphcyl bifocal over 12.38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V221500100PLENTICULAR (MYODISC), PER LENS, BIFOCAL                                         Lens lenticular bifocal     38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V221600100PLENTICULAR, NONASPHERIC, PER LENS, BIFOCAL                                      Lens lenticular nonaspheric 38      A                                                                                                     C                          D1F Q       198501012004010120031231N                           
V221700100PLENTICULAR, ASPHERIC LENS, BIFOCAL                                              Lens lenticular aspheric bif38      A                                                                                                     C                          D1F Q       198501012004010120031231N                           
V221800100PANISEIKONIC, PER LENS, BIFOCAL                                                  Lens aniseikonic bifocal    38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V221900100PBIFOCAL SEG WIDTH OVER 28MM                                                     Lens bifocal seg width over 38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V222000100PBIFOCAL ADD OVER 3.25D                                                          Lens bifocal add over 3.25d 38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V222100100PLENTICULAR LENS, PER LENS, BIFOCAL                                              Lenticular lens, bifocal    38      A                  2130.B                                                                             D                          D1F Q       2004010120040101        N                           
V229900100PSPECIALTY BIFOCAL (BY REPORT)                                                   Lens bifocal speciality     46      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230000100PSPHERE, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS                        Lens sphere trifocal 4.00d  38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230100100PSPHERE, TRIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS           Lens sphere trifocal 4.12-7.38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230200100PSPHERE, TRIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00, PER LENS           Lens sphere trifocal 7.12-2038      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230300100PSPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS  4.00D SPHERE, .12-2.00D       Lens sphcy trifocal 4.0/.12-38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230300200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V230400100PSPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.25-4.00D       Lens sphcy trifocal 4.0/2.2538      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230400200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V230500100PSPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00     Lens sphcy trifocal 4.0/4.2538      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230500200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V230600100PSPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D       Lens sphcyl trifocal 4.00/>638      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230600200QCYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V230700100PSPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, .12 Lens sphcy trifocal 4.25-7/.38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230700200QTO 2.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                          
V230800100PSPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,     Lens sphc trifocal 4.25-7/2.38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230800200Q2.12 TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V230900100PSPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,     Lens sphc trifocal 4.25-7/4.38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V230900200Q4.25 TO 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V231000100PSPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,     Lens sphc trifocal 4.25-7/>638      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V231000200QOVER 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                        
V231100100PSPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,    Lens sphc trifo 7.25-12/.25-38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V231100200Q.25 TO 2.25D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                      
V231200100PSPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,    Lens sphc trifo 7.25-12/2.2538      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V231200200Q2.25 TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V231300100PSPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,    Lens sphc trifo 7.25-12/4.2538      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V231300200Q4.25 TO 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V231400100PSPHEROCYLINDER, TRIFOCAL, SPHERE OVER PLUS OR MINUS 12 .00D, PER LENS           Lens sphcyl trifocal over 1238      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V231500100PLENTICULAR, (MYODISC), PER LENS, TRIFOCAL                                       Lens lenticular trifocal    38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V231600100PLENTICULAR NONASPHERIC, PER LENS, TRIFOCAL                                      Lens lenticular nonaspheric 38      A                                                                                                     C                          D1F Q       198501012004010120031231N                           
V231700100PLENTICULAR, ASPHERIC LENS, TRIFOCAL                                             Lens lenticular aspheric tri38      A                                                                                                     C                          D1F Q       198501012004010120031231N                           
V231800100PANISEIKONIC LENS, TRIFOCAL                                                      Lens aniseikonic trifocal   38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V231900100PTRIFOCAL SEG WIDTH OVER 28 MM                                                   Lens trifocal seg width > 2838      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V232000100PTRIFOCAL ADD OVER 3.25D                                                         Lens trifocal add over 3.25d38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V232100100PLENTICULAR LENS, PER LENS, TRIFOCAL                                             Lenticular lens, trifocal   38      A                  2130.B                                                                             D                          D1F Q       2004010120040101        N                           
V239900100PSPECIALTY TRIFOCAL (BY REPORT)                                                  Lens trifocal speciality    46      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V241000100PVARIABLE ASPHERICITY LENS, SINGLE VISION, FULL FIELD, GLASS OR PLASTIC, PER LENSLens variab asphericity sing38      A                                                                                                     C                          D1F Q       1984010120031001        N                           
V243000100PVARIABLE ASPHERICITY LENS, BIFOCAL, FULL FIELD, GLASS OR PLASTIC, PER LENS      Lens variable asphericity bi38      A                                                                                                     C                          D1F Q       1984010120031001        N                           
V249900100PVARIABLE SPHERICITY LENS, OTHER TYPE                                            Variable asphericity lens   46      A                                                                                                     C                          D1F Q       1984010120031001        N                           
V250000100PCONTACT LENS, PMMA, SPHERICAL, PER LENS                                         Contact lens pmma spherical 38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V250100100PCONTACT LENS, PMMA, TORIC OR PRISM BALLAST, PER LENS                            Cntct lens pmma-toric/prism 38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V250200100PCONTACT LENS PMMA, BIFOCAL, PER LENS                                            Contact lens pmma bifocal   38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V250300100PCONTACT LENS, PMMA, COLOR VISION DEFICIENCY, PER LENS                           Cntct lens pmma color vision38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V251000100PCONTACT LENS, GAS PERMEABLE, SPHERICAL, PER LENS                                Cntct gas permeable sphericl38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V251100100PCONTACT LENS, GAS PERMEABLE, TORIC, PRISM BALLAST, PER LENS                     Cntct toric prism ballast   38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V251200100PCONTACT LENS, GAS PERMEABLE, BIFOCAL, PER LENS                                  Cntct lens gas permbl bifocl38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V251300100PCONTACT LENS, GAS PERMEABLE, EXTENDED WEAR, PER LENS                            Contact lens extended wear  38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V252000100PCONTACT LENS, HYDROPHILIC, SPHERICAL, PER LENS                                  Contact lens hydrophilic    38      A45-7  65-1                                                                                           D                          D1F Q       1984010120031001        N                           
V252100100PCONTACT LENS, HYDROPHILIC, TORIC, OR PRISM BALLAST, PER LENS                    Cntct lens hydrophilic toric38      A45-7  65-1                                                                                           D                          D1F Q       1985010120031001        N                           
V252200100PCONTACT LENS, HYDROPHILLIC, BIFOCAL, PER LENS                                   Cntct lens hydrophil bifocl 38      A45-7  65-1                                                                                           D                          D1F Q       1985010120031001        N                           
V252300100PCONTACT LENS, HYDROPHILIC, EXTENDED WEAR, PER LENS                              Cntct lens hydrophil extend 38      A45-7  65-1                                                                                           D                          D1F Q       1985010120031001        N                           
V253000100PCONTACT LENS, SCLERAL, GAS IMPERMEABLE, PER LENS (FOR CONTACT LENS              Contact lens gas impermeable38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V253000200QMODIFICATION, SEE 92325)                                                                                                                                                                                                                                                                                             
V253100100PCONTACT LENS, SCLERAL, GAS PERMEABLE, PER LENS (FOR CONTACT LENS MODIFICATION,  Contact lens gas permeable  38      A65-3                                                                                                 D                          D1F Q       1996010120031001        N                           
V253100200QSEE 92325)                                                                                                                                                                                                                                                                                                           
V259900100PCONTACT LENS, OTHER TYPE                                                        Contact lens/es other type  46      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V260000100PHAND HELD LOW VISION AIDS AND OTHER NONSPECTACLE MOUNTED AIDS                   Hand held low vision aids   46      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V261000100PSINGLE LENS SPECTACLE MOUNTED LOW VISION AIDS                                   Single lens spectacle mount 46      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V261500100PTELESCOPIC AND OTHER COMPOUND LENS SYSTEM, INCLUDING DISTANCE VISION            Telescop/othr compound lens 46      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V261500200QTELESCOPIC, NEAR VISION TELESCOPES AND COMPOUND MICROSCOPIC LENS SYSTEM                                                                                                                                                                                                                                              
V262300100PPROSTHETIC EYE, PLASTIC, CUSTOM                                                 Plastic eye prosth custom   38      A                  2133                                                                               D                          D1F P       1985010120031001        N                           
V262400100PPOLISHING/RESURFACING OF OCULAR PROSTHESIS                                      Polishing artifical eye     38      A                                                                                                     C                          D1F P       1993010120031001        N                           
V262500100PENLARGEMENT OF OCULAR PROSTHESIS                                                Enlargemnt of eye prosthesis38      A                                                                                                     C                          D1F P       1993010120031001        N                           
V262600100PREDUCTION OF OCULAR PROSTHESIS                                                  Reduction of eye prosthesis 38      A                                                                                                     C                          D1F P       1993010120031001        N                           
V262700100PSCLERAL COVER SHELL                                                             Scleral cover shell         38      A65-3                                                                                                 D                          D1F P       1993010120031001        N                           
V262800100PFABRICATION AND FITTING OF OCULAR CONFORMER                                     Fabrication & fitting       38      A                                                                                                     C                          D1F P       1993010120031001        N                           
V262900100PPROSTHETIC EYE, OTHER TYPE                                                      Prosthetic eye other type   46      A                                                                                                     C                          D1F P       1985010120031001        N                           
V263000100PANTERIOR CHAMBER INTRAOCULAR LENS                                               Anter chamber intraocul lens52      A                  2130                                                                               D                          D1F Q       1985010120031001        N                           
V263100100PIRIS SUPPORTED INTRAOCULAR LENS                                                 Iris support intraoclr lens 52      A                  2130                                                                               D                          D1F Q       1985010120031001        N                           
V263200100PPOSTERIOR CHAMBER INTRAOCULAR LENS                                              Post chmbr intraocular lens 52      A                  2130                                                                               D                          D1F Q       1985010120031001        N                           
V270000100PBALANCE LENS, PER LENS                                                          Balance lens                38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V270200100PDELUXE LENS FEATURE                                                             Deluxe lens feature         00      9                  2130B                                                                              M                          D1F Q       2005010120050101        N                           
V271000100PSLAB OFF PRISM, GLASS OR PLASTIC, PER LENS                                      Glass/plastic slab off prism38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V271500100PPRISM, PER LENS                                                                 Prism lens/es               38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V271800100PPRESS-ON LENS, FRESNELL PRISM, PER LENS                                         Fresnell prism press-on lens38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V273000100PSPECIAL BASE CURVE, GLASS OR PLASTIC, PER LENS                                  Special base curve          38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V274000100PTINT, PLASTIC, ROSE 1 OR 2 PER LENS                                             Rose tint plastic           38      A                  2130B                                                                              D                          D1F Q       198501012004010120031231N                           
V274100100PTINT, PLASTIC, OTHER THAN ROSE 1-2, PER LENS                                    Non-rose tint plastic       38      A                  2130B                                                                              D                          D1F Q       198501012004010120031231N                           
V274200100PTINT, GLASS ROSE 1 OR 2, PER LENS                                               Rose tint glass             38      A                  2130B                                                                              D                          D1F Q       198501012004010120031231N                           
V274300100PTINT, GLASS OTHER THAN ROSE 1 OR 2, PER LENS                                    Non-rose tint glass         38      A                  2130B                                                                              D                          D1F Q       198501012004010120031231N                           
V274400100PTINT, PHOTOCHROMATIC, PER LENS                                                  Tint photochromatic lens/es 38      A                  2130B                                                                              D                          D1F Q       1985010120031001        N                           
V274500100PADDITION TO LENS; TINT, ANY COLOR, SOLID, GRADIENT OR EQUAL, EXCLUDES           Tint, any color/solid/grad  38      A                  2130.B                                                                             D                          D1F Q       2004010120050101        N                           
V274500200QPHOTOCHROMATIC, ANY LENS MATERIAL, PER LENS                                                                                                                                                                                                                                                                          
V275000100PANTI-REFLECTIVE COATING, PER LENS                                               Anti-reflective coating     38      A                  2130B                                                                              D                          D1F Q       1985010120031001        N                           
V275500100PU-V LENS, PER LENS                                                              UV lens/es                  38      A                  2130B                                                                              D                          D1F Q       1985010120031001        N                           
V275600100PEYE GLASS CASE                                                                  Eye glass case              00      9                                                                                                     I                          Z2  Q       2004010120040101        N                           
V276000100PSCRATCH RESISTANT COATING, PER LENS                                             Scratch resistant coating   38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V276100100PMIRROR COATING, ANY TYPE, SOLID, GRADIENT OR EQUAL, ANY LENS MATERIAL, PER LENS Mirror coating              38      A                  2130.B                                                                             D                          D1F Q       2004010120040101        N                           
V276200100PPOLARIZATION, ANY LENS MATERIAL, PER LENS                                       Polarization, any lens      38      A                  2130.B                                                                             D                          D1F Q       2004010120040101        N                           
V277000100POCCLUDER LENS, PER LENS                                                         Occluder lens/es            38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V278000100POVERSIZE LENS, PER LENS                                                         Oversize lens/es            38      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V278100100PPROGRESSIVE LENS, PER LENS                                                      Progressive lens per lens   00      9                                                                                                     C                          D1F Q       1996010120031001        N                           
V278200100PLENS, INDEX 1.54 TO 1.65 PLASTIC OR 1.60 TO 1.79 GLASS, EXCLUDES POLYCARBONATE, Lens, 1.54-1.65 p/1.60-1.79g38      A                  2130.B                                                                             D                          D1F Q       2004010120040101        N                           
V278200200QPER LENS                                                                                                                                                                                                                                                                                                             
V278300100PLENS, INDEX GREATER THAN OR EQUAL TO 1.66 PLASTIC OR GREATER THAN OR EQUAL TO   Lens, >= 1.66 p/>=1.80 g    38      A                  2130.B                                                                             D                          D1F Q       2004010120040101        N                           
V278300200Q1.80 GLASS, EXCLUDES POLYCARBONATE, PER LENS                                                                                                                                                                                                                                                                         
V278400100PLENS, POLYCARBONATE OR EQUAL, ANY INDEX, PER LENS                               Lens polycarb or equal      38      A                  2130.B                                                                             D                          D1F Q       2004010120040101        N                           
V278500100PPROCESSING, PRESERVING AND TRANSPORTING CORNEAL TISSUE                          Corneal tissue processing   46      A                                                                                                     C                          D1F Q       1990010120031001        N                           
V278600100PSPECIALTY OCCUPATIONAL MULTIFOCAL LENS, PER LENS                                Occupational multifocal lens38      A                  2130.B                                                                             D                          D1F Q       2004010120040101        N                           
V278800100PPRESBYOPIA CORRECTING FUNCTION OF INTRAOCULAR LENS                              Presbyopia-correct function 00      9                                          1862(a)(7)                                                 S                          Z2  Q       2006010120060101        A                           
V279000100PAMNIOTIC MEMBRANE FOR SURGICAL RECONSTRUCTION, PER PROCEDURE                    Amniotic membrane           57      A                                                                                                     C                          Z2  Q       2001010120031001        N                           
V279700100PVISION SUPPLY, ACCESSORY AND/OR SERVICE COMPONENT OF ANOTHER HCPCS VISION CODE  Vis item/svc in other code  00      9                                                                                                     C                          D1F Q       2004010120040101        N                           
V279900100PVISION SERVICE, MISCELLANEOUS                                                   Miscellaneous vision service46      A                                                                                                     C                          D1F Q       1985010120031001        N                           
V500800100PHEARING SCREENING                                                               Hearing screening           00      9                  2320                                                                               M                          O1F K       1990010119950101        N                           
V501000100PASSESSMENT FOR HEARING AID                                                      Assessment for hearing aid  00      9                                          1862A7                                                     S                          O1F K       1984010119950101        N                           
V501100100PFITTING/ORIENTATION/CHECKING OF HEARING AID                                     Hearing aid fitting/checking00      9                                          1862A7                                                     S                          O1F K       1990010119950101        N                           
V501400100PREPAIR/MODIFICATION OF A HEARING AID                                            Hearing aid repair/modifying00      9                                          1862A7                                                     S                          O1F K       1990010119950101        N                           
V502000100PCONFORMITY EVALUATION                                                           Conformity evaluation       00      9                                          1862A7                                                     S                          O1F K       1984010119950101        N                           
V503000100PHEARING AID, MONAURAL, BODY WORN, AIR CONDUCTION                                Body-worn hearing aid air   00      9                                          1862A7                                                     S                          O1F K       1986010119950101        N                           
V504000100PHEARING AID, MONAURAL, BODY WORN, BONE CONDUCTION                               Body-worn hearing aid bone  00      9                                          1862A7                                                     S                          O1F K       1986010119950101        N                           
V505000100PHEARING AID, MONAURAL, IN THE EAR                                               Hearing aid monaural in ear 00      9                                          1862A7                                                     S                          O1F K       1982010120010101        N                           
V506000100PHEARING AID, MONAURAL, BEHIND THE EAR                                           Behind ear hearing aid      00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V507000100PGLASSES, AIR CONDUCTION                                                         Glasses air conduction      00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V508000100PGLASSES, BONE CONDUCTION                                                        Glasses bone conduction     00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V509000100PDISPENSING FEE, UNSPECIFIED HEARING AID                                         Hearing aid dispensing fee  00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V509500100PSEMI-IMPLANTABLE MIDDLE EAR HEARING PROSTHESIS                                  Implant mid ear hearing pros00      9                                          1862A7                                                     S                          O1F K       2003010120030101        N                           
V510000100PHEARING AID, BILATERAL, BODY WORN                                               Body-worn bilat hearing aid 00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V511000100PDISPENSING FEE, BILATERAL                                                       Hearing aid dispensing fee  00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V512000100PBINAURAL, BODY                                                                  Body-worn binaur hearing aid00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V513000100PBINAURAL, IN THE EAR                                                            In ear binaural hearing aid 00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V514000100PBINAURAL, BEHIND THE EAR                                                        Behind ear binaur hearing ai00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V515000100PBINAURAL, GLASSES                                                               Glasses binaural hearing aid00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V516000100PDISPENSING FEE, BINAURAL                                                        Dispensing fee binaural     00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V517000100PHEARING AID, CROS, IN THE EAR                                                   Within ear cros hearing aid 00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V518000100PHEARING AID, CROS, BEHIND THE EAR                                               Behind ear cros hearing aid 00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V519000100PHEARING AID, CROS, GLASSES                                                      Glasses cros hearing aid    00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V520000100PDISPENSING FEE, CROS                                                            Cros hearing aid dispens fee00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V521000100PHEARING AID, BICROS, IN THE EAR                                                 In ear bicros hearing aid   00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V522000100PHEARING AID, BICROS, BEHIND THE EAR                                             Behind ear bicros hearing ai00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V523000100PHEARING AID, BICROS, GLASSES                                                    Glasses bicros hearing aid  00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V524000100PDISPENSING FEE, BICROS                                                          Dispensing fee bicros       00      9                                          1862A7                                                     S                          O1F K       1982010119950101        N                           
V524100100PDISPENSING FEE, MONAURAL HEARING AID, ANY TYPE                                  Dispensing fee, monaural    00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V524200100PHEARING AID, ANALOG, MONAURAL, CIC (COMPLETELY IN THE EAR CANAL)                Hearing aid, monaural, cic  00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V524300100PHEARING AID, ANALOG, MONAURAL, ITC (IN THE CANAL)                               Hearing aid, monaural, itc  00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V524400100PHEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, CIC                       Hearing aid, prog, mon, cic 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V524500100PHEARING AID, DIGITALLY PROGRAMMABLE, ANALOG, MONAURAL, ITC                      Hearing aid, prog, mon, itc 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V524600100PHEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, ITE (IN THE EAR)          Hearing aid, prog, mon, ite 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V524700100PHEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, BTE (BEHIND THE EAR)      Hearing aid, prog, mon, bte 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V524800100PHEARING AID, ANALOG, BINAURAL, CIC                                              Hearing aid, binaural, cic  00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V524900100PHEARING AID, ANALOG, BINAURAL, ITC                                              Hearing aid, binaural, itc  00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525000100PHEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, CIC                       Hearing aid, prog, bin, cic 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525100100PHEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, ITC                       Hearing aid, prog, bin, itc 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525200100PHEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, ITE                              Hearing aid, prog, bin, ite 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525300100PHEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, BTE                              Hearing aid, prog, bin, bte 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525400100PHEARING AID, DIGITAL, MONAURAL, CIC                                             Hearing id, digit, mon, cic 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525500100PHEARING AID, DIGITAL, MONAURAL, ITC                                             Hearing aid, digit, mon, itc00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525600100PHEARING AID, DIGITAL, MONAURAL, ITE                                             Hearing aid, digit, mon, ite00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525700100PHEARING AID, DIGITAL, MONAURAL, BTE                                             Hearing aid, digit, mon, bte00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525800100PHEARING AID, DIGITAL, BINAURAL, CIC                                             Hearing aid, digit, bin, cic00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V525900100PHEARING AID, DIGITAL, BINAURAL, ITC                                             Hearing aid, digit, bin, itc00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526000100PHEARING AID, DIGITAL, BINAURAL, ITE                                             Hearing aid, digit, bin, ite00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526100100PHEARING AID, DIGITAL, BINAURAL, BTE                                             Hearing aid, digit, bin, bte00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526200100PHEARING AID, DISPOSABLE, ANY TYPE, MONAURAL                                     Hearing aid, disp, monaural 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526300100PHEARING AID, DISPOSABLE, ANY TYPE, BINAURAL                                     Hearing aid, disp, binaural 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526400100PEAR MOLD/INSERT, NOT DISPOSABLE, ANY TYPE                                       Ear mold/insert             00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526500100PEAR MOLD/INSERT, DISPOSABLE, ANY TYPE                                           Ear mold/insert, disp       00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526600100PBATTERY FOR USE IN HEARING DEVICE                                               Battery for hearing device  00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526700100PHEARING AID SUPPLIES / ACCESSORIES                                              Hearing aid supply/accessory00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526800100PASSISTIVE LISTENING DEVICE, TELEPHONE AMPLIFIER, ANY TYPE                       ALD Telephone Amplifier     00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V526900100PASSISTIVE LISTENING DEVICE, ALERTING, ANY TYPE                                  Alerting device, any type   00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V527000100PASSISTIVE LISTENING DEVICE, TELEVISION AMPLIFIER, ANY TYPE                      ALD, TV amplifier, any type 00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V527100100PASSISTIVE LISTENING DEVICE, TELEVISION CAPTION DECODER                          ALD, TV caption decoder     00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V527200100PASSISTIVE LISTENING DEVICE, TDD                                                 Tdd                         00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V527300100PASSISTIVE LISTENING DEVICE, FOR USE WITH COCHLEAR IMPLANT                       ALD for cochlear implant    00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V527400100PASSISTIVE LISTENING DEVICE, NOT OTHERWISE SPECIFIED                             ALD unspecified             00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V527500100PEAR IMPRESSION, EACH                                                            Ear impression              00      9                                          1862A7                                                     S                          O1F K       2002010120020101        N                           
V529800100PHEARING AID, NOT OTHERWISE CLASSIFIED                                           Hearing aid noc             00      9                                          1862A7                                                     S                          O1F K       2003010120030101        N                           
V529900100PHEARING SERVICE, MISCELLANEOUS                                                  Hearing service             13      A                  2320                                                                               D                          O1F K       1982010119950101        N                           
V533600100PREPAIR/MODIFICATION OF AUGMENTATIVE COMMUNICATIVE SYSTEM OR DEVICE (EXCLUDES    Repair communication device 00      9                                          1862A7                                                     S                          O1F 1       1990010119910101        N                           
V533600200QADAPTIVE HEARING AID)                                                                                                                                                                                                                                                                                                
V536200100PSPEECH SCREENING                                                                Speech screening            00      9                                          1862(a)(7)                                                 S                          O1F 1W      1990010120040101        N                           
V536300100PLANGUAGE SCREENING                                                              Language screening          00      9                                          1862(a)(7)                                                 S                          O1F 1W      1990010120040101        N                           
V536400100PDYSPHAGIA SCREENING                                                             Dysphagia screening         00      9                                          1862(a)(7)                                                 S                          O1F 1W      1990010120040101        N                           
