   A1001007DRESSING FOR ONE WOUND                                                          Dressing for one wound                                                                                                                    C                                     02002070120020701        N                           
   A2001007DRESSING FOR TWO WOUNDS                                                         Dressing for two wounds                                                                                                                   C                                     02002070120020701        N                           
   A3001007DRESSING FOR THREE WOUNDS                                                       Dressing for three wounds                                                                                                                 C                                     02002070120020701        N                           
   A4001007DRESSING FOR FOUR WOUNDS                                                        Dressing for four wounds                                                                                                                  C                                     02002070120020701        N                           
   A5001007DRESSING FOR FIVE WOUNDS                                                        Dressing for five wounds                                                                                                                  C                                     02002070120020701        N                           
   A6001007DRESSING FOR SIX WOUNDS                                                         Dressing for six wounds                                                                                                                   C                                     02002070120020701        N                           
   A7001007DRESSING FOR SEVEN WOUNDS                                                       Dressing for seven wounds                                                                                                                 C                                     02002070120020701        N                           
   A8001007DRESSING FOR EIGHT WOUNDS                                                       Dressing for eight wounds                                                                                                                 C                                     02002070120020701        N                           
   A9001007DRESSING FOR NINE OR MORE WOUNDS                                                Dressing for 9 or more wound                                                                                                              C                                     02002070120020701        N                           
   AA001007ANESTHESIA SERVICES PERFORMED PERSONALLY BY ANESTHESIOLOGIST                    Anesthesia perf by anesgst                             3350.5                                                                             D                                     01984010120010101        N                           
   AD001007MEDICAL SUPERVISION BY A PHYSICIAN: MORE THAN FOUR CONCURRENT ANESTHESIA        MD supervision, >4 anes proc                           3350.5                                                                             D                                     01984010120010101        N                           
   AD002008PROCEDURES                                                                                                                                                                                                                                                                                                           
   AE001007REGISTERED DIETICIAN                                                            Registered dietician                                                                                                                      C                                     02005010120050101        N                           
   AF001007SPECIALTY PHYSICIAN                                                             Specialty physician                                                                                                                       C                                     02005010120050101        N                           
   AG001007PRIMARY PHYSICIAN                                                               Primary physician                                                                                                                         C                                     02005010120050101        N                           
   AH001007CLINICAL PSYCHOLOGIST                                                           Clinical psychologist                                  2150    5112                                                                       D                                     01991010119970101        N                           
   AJ001007CLINICAL SOCIAL WORKER                                                          Clinical social worker                                 2152    5113                                                                       D                                     01991010119970101        N                           
   AK001007NON PARTICIPATING PHYSICIAN                                                     Non participating physician                                                                                                               C                                     02005010120050101        N                           
   AM001007PHYSICIAN, TEAM MEMBER SERVICE                                                  Physician, team member svc                             4105.7                                                       QM                    D                      0069           01991010119970101        N                           
   AP001007DETERMINATION OF REFRACTIVE STATE WAS NOT PERFORMED IN THE COURSE OF DIAGNOSTIC No dtmn of refractive state                                                                                                               C                                     01984010119970101        N                           
   AP002008OPHTHALMOLOGICAL EXAMINATION                                                                                                                                                                                                                                                                                         
   AQ001007PHYSICIAN PROVIDING A SERVICE IN AN UNLISTED HEALTH PROFESSIONAL SHORTAGE AREA  Physician service HPSA area                                                                                                               C                                     02006010120060101        A                           
   AQ002008(HPSA)                                                                                                                                                                                                                                                                                                               
   AR001007PHYSICIAN PROVIDER SERVICES IN A PHYSICIAN SCARCITY AREA                        Physician scarcity area                                                                                                                   C                                     02005010120050101        N                           
   AS001007PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR CLINICAL NURSE SPECIALIST SERVICES  Assistant at surgery service                                                                                                              C                      0069           01988010119990101        N                           
   AS002008FOR ASSISTANT AT SURGERY                                                                                                                                                                                                                                                                                             
   AT001007ACUTE TREATMENT (THIS MODIFIER SHOULD BE USED WHEN REPORTING SERVICE 98940,     Acute treatment                                                                                                                           C                                     01984010119980101        N                           
   AT00200898941, 98942)                                                                                                                                                                                                                                                                                                        
   AU001007ITEM FURNISHED IN CONJUNCTION WITH A UROLOGICAL, OSTOMY, OR TRACHEOSTOMY SUPPLY Uro, ostomy or trach item                                                                                                                 C                                     02003010120030101        N                           
   AV001007ITEM FURNISHED IN CONJUNCTION WITH A PROSTHETIC DEVICE, PROSTHETIC OR ORTHOTIC  Item w prosthetic/orthotic                                                                                                                C                                     02003010120030101        N                           
   AW001007ITEM FURNISHED IN CONJUNCTION WITH A SURGICAL DRESSING                          Item w a surgical dressing                                                                                                                C                                     02003010120030101        N                           
   AX001007ITEM FURNISHED IN CONJUNCTION WITH DIALYSIS SERVICES                            Item w dialysis services                                                                                                                  C                      0000           02003010120030101        N                           
   BA001007ITEM FURNISHED IN CONJUNCTION WITH PARENTERAL ENTERAL NUTRITION (PEN) SERVICES  Item w pen services                                                                                                                       C                                     02003010120030101        N                           
   BL001007SPECIAL ACQUISITION OF BLOOD AND BLOOD PRODUCTS                                 Spec acquisition blood prods                                                                                                              C                                     02005070120050701        A                           
   BO001007ORALLY ADMINISTERED NUTRITION, NOT BY FEEDING TUBE                              Nutrition oral admin no tube                                                                                                              C                                     02003010120030101        N                           
   BP001007THE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND HAS    Bene electd to purchase item                                                                                                              C                                     01992010119970101        N                           
   BP002008ELECTED TO PURCHASE THE ITEM                                                                                                                                                                                                                                                                                         
   BR001007THE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND HAS    Bene elected to rent item                                                                                                                 C                                     01992010119970101        N                           
   BR002008ELECTED TO RENT THE ITEM                                                                                                                                                                                                                                                                                             
   BU001007THE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND AFTER  Bene undecided on purch/rent                                                                                                              C                                     01992010119970101        N                           
   BU00200830 DAYS HAS NOT INFORMED THE SUPPLIER OF HIS/HER DECISION                                                                                                                                                                                                                                                            
   CA001007PROCEDURE PAYABLE ONLY IN THE INPATIENT SETTING WHEN PERFORMED EMERGENTLY ON AN Procedure payable inpatient                                                                                                               C                                     02003010120030101        N                           
   CA002008OUTPATIENT WHO EXPIRES PRIOR TO ADMISSION                                                                                                                                                                                                                                                                            
   CB001007SERVICE ORDERED BY A RENAL DIALYSIS FACILITY (RDF) PHYSICIAN AS PART OF THE     ESRD bene part a snf-sep pay                                                                                                              C                                     02003040120040101        N                           
   CB002008ESRD BENEFICIARY'S DIALYSIS BENEFIT, IS NOT PART OF THE COMPOSITE RATE, AND IS                                                                                                                                                                                                                                       
   CB003008SEPARATELY REIMBURSABLE                                                                                                                                                                                                                                                                                              
   CC001007PROCEDURE CODE CHANGE (USE 'CC' WHEN THE PROCEDURE CODE SUBMITTED WAS CHANGED   Procedure code change                                                                                                                     C                                     01990010119970101        N                           
   CC002008EITHER FOR ADMINISTRATIVE REASONS OR BECAUSE AN INCORRECT CODE WAS FILED)                                                                                                                                                                                                                                            
   CD001007AMCC TEST HAS BEEN ORDERED BY AN ESRD FACILITY OR MCP PHYSICIAN THAT IS PART OF AMCC test for ESRD or MCP MD                           4270.2                                                                             D                                     02004010120040101        N                           
   CD002008THE COMPOSITE RATE AND IS NOT SEPARATELY BILLABLE                                                                                                                                                                                                                                                                    
   CE001007AMCC TEST HAS BEEN ORDERED BY AN ESRD FACILITY OR MCP PHYSICIAN THAT IS A       Med neces AMCC tst sep reimb                           4270.2                                                                             D                                     02004010120040101        N                           
   CE002008COMPOSITE RATE TEST BUT IS BEYOND THE NORMAL FREQUENCY COVERED UNDER THE RATE                                                                                                                                                                                                                                        
   CE003008AND IS SEPARATELY REIMBURSABLE BASED ON MEDICAL NECESSITY                                                                                                                                                                                                                                                            
   CF001007AMCC TEST HAS BEEN ORDERED BY AN ESRD FACILITY OR MCP PHYSICIAN THAT IS NOT     AMCC tst not composite rate                            4270.2                                                                             D                                     02004010120040101        N                           
   CF002008PART OF THE COMPOSITE RATE AND IS SEPARATELY BILLABLE                                                                                                                                                                                                                                                                
   CR001007CATASTROPHE/DISASTER RELATED                                                    Catastrophe/disaster related                                                                                                              C                                     02005082120050821        A                           
   E1001007UPPER LEFT, EYELID                                                              Upper left eyelid                                                                                                                         C                                     01995010119990101        N                           
   E2001007LOWER LEFT, EYELID                                                              Lower left eyelid                                                                                                                         C                                     01995010119990101        N                           
   E3001007UPPER RIGHT, EYELID                                                             Upper right eyelid                                                                                                                        C                                     01995010119990101        N                           
   E4001007LOWER RIGHT, EYELID                                                             Lower right eyelid                                                                                                                        C                                     01995010119990101        N                           
   EJ001007SUBSEQUENT CLAIMS FOR A DEFINED COURSE OF THERAPY, E.G., EPO, SODIUM            Subsequent claim                                       4273.2                                                                             D                                     01991010120000101        N                           
   EJ002008HYALURONATE, INFLIXIMAB                                                                                                                                                                                                                                                                                              
   EM001007EMERGENCY RESERVE SUPPLY (FOR ESRD BENEFIT ONLY)                                Emer reserve supply (ESRD)                             3045.7                                                                             D                                     01991010119970101        N                           
   EP001007SERVICE PROVIDED AS PART OF MEDICAID EARLY PERIODIC SCREENING DIAGNOSIS AND     Medicaid EPSDT program svc                                                                                                                C                                     01987010119970101        N                           
   EP002008TREATMENT (EPSDT) PROGRAM                                                                                                                                                                                                                                                                                            
   ET001007EMERGENCY SERVICES                                                              Emergency Services                                                                                                                        C                                     01984010120020101        N                           
   EY001007NO PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER ORDER FOR THIS ITEM OR      No md order for item/service                                                                                                              C                                     02003010120030101        N                           
   EY002008SERVICE                                                                                                                                                                                                                                                                                                              
   F1001007LEFT HAND, SECOND DIGIT                                                         Left hand, second digit                                                                                                                   C                                     01995010119990101        N                           
   F2001007LEFT HAND, THIRD DIGIT                                                          Left hand, third digit                                                                                                                    C                                     01995010119990101        N                           
   F3001007LEFT HAND, FOURTH DIGIT                                                         Left hand, fourth digit                                                                                                                   C                                     01995010119990101        N                           
   F4001007LEFT HAND, FIFTH DIGIT                                                          Left hand, fifth digit                                                                                                                    C                                     01995010119990101        N                           
   F5001007RIGHT HAND, THUMB                                                               Right hand, thumb                                                                                                                         C                                     01995010119990101        N                           
   F6001007RIGHT HAND, SECOND DIGIT                                                        Right hand, second digit                                                                                                                  C                                     01995010119990101        N                           
   F7001007RIGHT HAND, THIRD DIGIT                                                         Right hand, third digit                                                                                                                   C                                     01995010119990101        N                           
   F8001007RIGHT HAND, FOURTH DIGIT                                                        Right hand, fourth digit                                                                                                                  C                                     01995010119990101        N                           
   F9001007RIGHT HAND, FIFTH DIGIT                                                         Right hand, fifth digit                                                                                                                   C                                     01995010119990101        N                           
   FA001007LEFT HAND, THUMB                                                                Left hand, thumb                                                                                                                          C                                     01995010119990101        N                           
   FB001007ITEM PROVIDED WITHOUT COST TO PROVIDER, SUPPLIER OR PRACTITIONER (EXAMPLES, BUT Item provided without cost                                                                                                                I                                     02006010120060101        A                           
   FB002008NOT LIMITED TO: COVERED UNDER WARRANTY, REPLACED DUE TO DEFECT, FREE SAMPLES)                                                                                                                                                                                                                                        
   FP001007SERVICE PROVIDED AS PART OF FAMILY PLANNING PROGRAM                             Svc part of family plan pgm                                                                                                               C                                     01987010120050101        N                           
   G1001007MOST RECENT URR READING OF LESS THAN 60                                         URR reading of less than 60                                                                                                               C                                     01997010119980101        N                           
   G2001007MOST RECENT URR READING OF 60 TO 64.9                                            URR reading of 60 to 64.9                                                                                                                C                                     01997010119980101        N                           
   G3001007MOST RECENT URR READING OF 65 TO 69.9                                           URR  reading of 65 to 69.9                                                                                                                C                                     01997010119980101        N                           
   G4001007MOST RECENT URR READING OF 70 TO 74.9                                           URR reading of 70 to 74.9                                                                                                                 C                                     01997010119970101        N                           
   G5001007MOST RECENT URR READING OF 75 OR GREATER                                        URR reading of 75 or greater                                                                                                              C                                     01997010119980101        N                           
   G6001007ESRD PATIENT FOR WHOM LESS THAN SIX DIALYSIS SESSIONS HAVE BEEN PROVIDED IN A   ESRD patient <6 dialysis/mth                                                                                                              C                                     01998050119980501        N                           
   G6002008MONTH                                                                                                                                                                                                                                                                                                                
   G7001007PREGNANCY RESULTED FROM RAPE OR INCEST OR PREGNANCY CERTIFIED BY PHYSICIAN AS   Payment limits do not apply          35-99             2005.1                                                                             D                      0084           01999070119990701        N                           
   G7002008LIFE THREATENING                                                                                                                                                                                                                                                                                                     
   G8001007MONITORED ANESTHESIA CARE (MAC) FOR DEEP COMPLEX, COMPLICATED, OR MARKEDLY      Monitored anesthesia care                                                                                                                 C                      0083           01999070119990701        N                           
   G8002008INVASIVE SURGICAL PROCEDURE                                                                                                                                                                                                                                                                                          
   G9001007MONITORED ANESTHESIA CARE FOR PATIENT WHO HAS HISTORY OF SEVERE                 MAC for at risk patient                                                                                                                   C                                     01999070119990701        N                           
   G9002008CARDIO-PULMONARY CONDITION                                                                                                                                                                                                                                                                                           
   GA001007WAIVER OF LIABILITY STATEMENT ON FILE                                           Waiver of Liability on file                                                                                                               C                                     01995010119970101        N                           
   GB001007CLAIM BEING RE-SUBMITTED FOR PAYMENT BECAUSE IT IS NO LONGER COVERED UNDER A    Claim resubmitted                                                                                                                         C                                     02002010120020101        N                           
   GB002008GLOBAL PAYMENT DEMONSTRATION                                                                                                                                                                                                                                                                                         
   GC001007THIS SERVICE HAS BEEN PERFORMED IN PART BY A RESIDENT UNDER THE DIRECTION OF A  Resident/teaching phys serv                            3350.5  4116                                                                       D                                     01997010120010101        N                           
   GC002008TEACHING PHYSICIAN                                                                                                                                                                                                                                                                                                   
   GE001007THIS SERVICE HAS BEEN PERFORMED BY A RESIDENT WITHOUT THE PRESENCE OF A         Resident prim care exception                           4116                                                                               D                                     01997010119970101        N                           
   GE002008TEACHING PHYSICIAN UNDER THE PRIMARY CARE EXCEPTION                                                                                                                                                                                                                                                                  
   GF001007NON-PHYSICIAN (E.G. NURSE PRACTITIONER (NP), CERTIFIED REGISTERED NURSE         Nonphysician serv c a hosp                                                                                                                C                                     02003040120030401        N                           
   GF002008ANESTHETIST (CRNA), CERTIFIED REGISTERED NURSE (CRN), CLINICAL NURSE SPECIALIST                                                                                                                                                                                                                                      
   GF003008(CNS), PHYSICIAN ASSISTANT (PA)) SERVICES IN A CRITICAL ACCESS HOSPITAL                                                                                                                                                                                                                                              
   GG001007PERFORMANCE AND PAYMENT OF A SCREENING MAMMOGRAM AND DIAGNOSTIC MAMMOGRAM ON    Payment screen mam + diagmam                                                                                                              C                                     02002010120020101        N                           
   GG002008THE SAME PATIENT, SAME DAY                                                                                                                                                                                                                                                                                           
   GH001007DIAGNOSTIC MAMMOGRAM CONVERTED FROM SCREENING MAMMOGRAM ON SAME DAY             Diag mammo to screening mamo                                                                                                              C                                     01998100119981001        N                           
   GJ001007"OPT OUT" PHYSICIAN OR PRACTITIONER EMERGENCY OR URGENT SERVICE                 Opt out provider of er srvc                                                                                                               C                                     01998100119981001        N                           
   GK001007ACTUAL ITEM/SERVICE ORDERED BY PHYSICIAN, ITEM ASSOCIATED WITH GA OR GZ MODIFIERActual item/service ordered                                                                                                               C                                     02002010120020101        N                           
   GL001007MEDICALLY UNNECESSARY UPGRADE PROVIDED INSTEAD OF STANDARD ITEM, NO CHARGE, NO  Upgraded item, no charge                                                                                                                  C                                     02002010120020101        N                           
   GL002008ADVANCE BENEFICIARY NOTICE (ABN)                                                                                                                                                                                                                                                                                     
   GM001007MULTIPLE PATIENTS ON ONE AMBULANCE TRIP                                         Multiple transports                                                                                                                       C                                     02002010120020101        N                           
   GN001007SERVICES DELIVERED UNDER AN OUTPATIENT SPEECH LANGUAGE PATHOLOGY PLAN OF CARE   OP speech language service                                                                                                                C                                     01999010120030101        N                           
   GO001007SERVICES DELIVERED UNDER AN OUTPATIENT OCCUPATIONAL THERAPY PLAN OF CARE        OP occupational therapy serv                                                                                                              C                                     01999010120030101        N                           
   GP001007SERVICES DELIVERED UNDER AN OUTPATIENT PHYSICAL THERAPY PLAN OF CARE            OP PT services                                                                                                                            C                                     01999010120030101        N                           
   GQ001007VIA ASYNCHRONOUS TELECOMMUNICATIONS SYSTEM                                      Telehealth store and forward                                                                                                              C                                     02001100120011001        N                           
   GR001007THIS SERVICE WAS PERFORMED IN WHOLE OR IN PART BY A RESIDENT IN A DEPARTMENT OF Service by va resident                                                                                                                    C                                     02006010120060101        A                           
   GR002008VETERANS AFFAIRS MEDICAL CENTER OR CLINIC, SUPERVISED IN ACCORDANCE WITH VA                                                                                                                                                                                                                                          
   GR003008POLICY                                                                                                                                                                                                                                                                                                               
   GS001007DOSAGE OF EPO OR DARBEPOIETIN ALFA HAS BEEN REDUCED 25% OF PRECEEDING MONTH'S   Epo/darbepoietin reduced 25%                           4273.1                                                                             D                                     02006010120060101        A                           
   GS002008DOSAGE                                                                                                                                                                                                                                                                                                               
   GT001007VIA INTERACTIVE AUDIO AND VIDEO TELECOMMUNICATION SYSTEMS                       InteractiveTelecommunication                                                                                                              D                      0073           01999010119990101        N                           
   GV001007ATTENDING PHYSICIAN NOT EMPLOYED OR PAID UNDER ARRANGEMENT BY THE PATIENT'S     Attending phys not hospice                             4175-5                                                                             D                                     02002010120020101        N                           
   GV002008HOSPICE PROVIDER                                                                                                                                                                                                                                                                                                     
   GW001007SERVICE NOT RELATED TO THE HOSPICE PATIENT'S TERMINAL CONDITION                 Service unrelated to term co                           4175-5                                                                             D                                     02002010120020101        N                           
   GY001007ITEM OR SERVICE STATUTORILY EXCLUDED OR DOES NOT MEET THE DEFINITION OF ANY     Statutorily excluded                                                                                                                      S                                     02002010120020101        N                           
   GY002008MEDICARE BENEFIT                                                                                                                                                                                                                                                                                                     
   GZ001007ITEM OR SERVICE EXPECTED TO BE DENIED AS NOT REASONABLE AND NECESSARY           Not reasonable and necessary                           2000                                                                               M                                     02002010120020101        N                           
   H9001007COURT-ORDERED                                                                   Court-ordered                                                                                                                             I                                     02003010120030101        N                           
   HA001007CHILD/ADOLESCENT PROGRAM                                                        Child/adolescent program                                                                                                                  I                                     02003010120030101        N                           
   HB001007ADULT PROGRAM, NON GERIATRIC                                                    Adult program non-geriatric                                                                                                               I                                     02003010120030101        N                           
   HC001007ADULT PROGRAM, GERIATRIC                                                        Adult program geriatric                                                                                                                   I                                     02003010120030101        N                           
   HD001007PREGNANT/PARENTING WOMEN'S PROGRAM                                              Pregnant/parenting program                                                                                                                I                                     02003010120030101        N                           
   HE001007MENTAL HEALTH PROGRAM                                                           Mental health program                                                                                                                     I                                     02003010120030101        N                           
   HF001007SUBSTANCE ABUSE PROGRAM                                                         Substance abuse program                                                                                                                   I                                     02003010120030101        N                           
   HG001007OPIOID ADDICTION TREATMENT PROGRAM                                              Opioid addiction tx program                                                                                                               I                                     02003010120030101        N                           
   HH001007INTEGRATED MENTAL HEALTH/SUBSTANCE ABUSE PROGRAM                                Mental hlth/substance abs pr                                                                                                              I                                     02003010120030101        N                           
   HI001007INTEGRATED MENTAL HEALTH AND MENTAL RETARDATION/DEVELOPMENTAL DISABILITIES      M hlth/m retrdtn/dev dis pro                                                                                                              I                                     02003010120030101        N                           
   HI002008PROGRAM                                                                                                                                                                                                                                                                                                              
   HJ001007EMPLOYEE ASSISTANCE PROGRAM                                                     Employee assistance program                                                                                                               I                                     02003010120030101        N                           
   HK001007SPECIALIZED MENTAL HEALTH PROGRAMS FOR HIGH-RISK POPULATIONS                    Spec hgh rsk mntl hlth pop p                                                                                                              I                                     02003010120030101        N                           
   HL001007INTERN                                                                          intern                                                                                                                                    I                                     02003010120030101        N                           
   HM001007LESS THAN BACHELOR DEGREE LEVEL                                                 Less than bachelor degree lv                                                                                                              I                                     02003010120030101        N                           
   HN001007BACHELORS DEGREE LEVEL                                                          Bachelors degree level                                                                                                                    I                                     02003010120030101        N                           
   HO001007MASTERS DEGREE LEVEL                                                            Masters degree level                                                                                                                      I                                     02003010120030101        N                           
   HP001007DOCTORAL LEVEL                                                                  Doctoral level                                                                                                                            I                                     02003010120030101        N                           
   HQ001007GROUP SETTING                                                                   Group setting                                                                                                                             I                                     02003010120030101        N                           
   HR001007FAMILY/COUPLE WITH CLIENT PRESENT                                               Family/couple w client prsnt                                                                                                              I                                     02003010120030101        N                           
   HS001007FAMILY/COUPLE WITHOUT CLIENT PRESENT                                            Family/couple w/o client prs                                                                                                              I                                     02003010120030101        N                           
   HT001007MULTI-DISCIPLINARY TEAM                                                         Multi-disciplinary team                                                                                                                   I                                     02003010120030101        N                           
   HU001007FUNDED BY CHILD WELFARE AGENCY                                                  Child welfare agency funded                                                                                                               I                                     02003010120030101        N                           
   HV001007FUNDED STATE ADDICTIONS AGENCY                                                  Funded state addiction agncy                                                                                                              I                                     02003010120030101        N                           
   HW001007FUNDED BY STATE MENTAL HEALTH AGENCY                                            State mntl hlth agncy funded                                                                                                              I                                     02003010120030101        N                           
   HX001007FUNDED BY COUNTY/LOCAL AGENCY                                                   County/local agency funded                                                                                                                I                                     02003010120030101        N                           
   HY001007FUNDED BY JUVENILE JUSTICE AGENCY                                               Funded by juvenile justice                                                                                                                I                                     02003010120030101        N                           
   HZ001007FUNDED BY CRIMINAL JUSTICE AGENCY                                               Criminal justice agncy fund                                                                                                               I                                     02003010120030101        N                           
   J1001007COMPETITIVE ACQUISITION PROGRAM NO-PAY SUBMISSION FOR A PRESCRIPTION NUMBER     CAP no-pay for prescript num                                                                                                              C                                     02006010120060101        A                           
   J2001007COMPETITIVE ACQUISITION PROGRAM, RESTOCKING OF EMERGENCY DRUGS AFTER EMERGENCY  CAP restock of emerg drugs                                                                                                                C                                     02006010120060101        A                           
   J2002008ADMINISTRATION                                                                                                                                                                                                                                                                                                       
   J3001007COMPETITIVE ACQUISITION PROGRAM (CAP), DRUG NOT AVAILABLE THROUGH CAP AS        CAP drug unavail thru cap                                                                                                                 C                                     02006010120060101        A                           
   J3002008WRITTEN, REIMBURSED UNDER AVERAGE SALES PRICE METHODOLOGY                                                                                                                                                                                                                                                            
   JW001007DRUG AMOUNT DISCARDED/NOT ADMINISTERED TO ANY PATIENT                           Discarded drug not administe                                                                                                              C                                     02003010120030101        N                           
   K0001007LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 0 - DOES NOT HAVE THE ABILITY OR    Lwr ext prost functnl lvl 0                                                                                                               C                                     01993010120030101        N                           
   K0002008POTENTIAL TO AMBULATE OR TRANSFER SAFELY WITH OR WITHOUT ASSISTANCE AND A                                                                                                                                                                                                                                            
   K0003008PROSTHESIS DOES NOT ENHANCE THEIR QUALITY OF LIFE OR MOBILITY.                                                                                                                                                                                                                                                       
   K1001007LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 1 - HAS THE ABILITY OR POTENTIAL TO Lwr ext prost functnl lvl 1                                                                                                               C                                     01993010119970101        N                           
   K1002008USE A PROSTHESIS FOR TRANSFERS OR AMBULATION ON LEVEL SURFACES AT FIXED                                                                                                                                                                                                                                              
   K1003008CADENCE. TYPICAL OF THE LIMITED AND UNLIMITED HOUSEHOLD AMBULATOR.                                                                                                                                                                                                                                                   
   K2001007LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 2 - HAS THE ABILITY OR POTENTIAL    Lwr ext prost functnl lvl 2                                                                                                               C                                     01993010119970101        N                           
   K2002008FOR AMBULATION WITH THE ABILITY TO TRAVERSE LOW LEVEL ENVIRONMENTAL BARRIERS                                                                                                                                                                                                                                         
   K2003008SUCH AS CURBS, STAIRS OR UNEVEN SURFACES.  TYPICAL OF THE LIMITED COMMUNITY                                                                                                                                                                                                                                          
   K2004008AMBULATOR.                                                                                                                                                                                                                                                                                                           
   K3001007LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 3 - HAS THE ABILITY OR POTENTIAL    Lwr ext prost functnl lvl 3                                                                                                               C                                     01993010119970101        N                           
   K3002008FOR AMBULATION WITH VARIABLE CADENCE.  TYPICAL OF THE COMMUNITY AMBULATOR WHO                                                                                                                                                                                                                                        
   K3003008HAS THE ABILITY TO TRANSVERSE MOST ENVIRONMENTAL BARRIERS AND MAY HAVE                                                                                                                                                                                                                                               
   K3004008VOCATIONAL, THERAPEUTIC, OR EXERCISE ACTIVITY THAT DEMANDS PROSTHETIC                                                                                                                                                                                                                                                
   K3005008UTILIZATION BEYOND SIMPLE LOCOMOTION.                                                                                                                                                                                                                                                                                
   K4001007LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 4 - HAS THE ABILITY OR POTENTIAL    Lwr ext prost functnl lvl 4                                                                                                               C                                     01993010119970101        N                           
   K4002008FOR PROSTHETIC AMBULATION THAT EXCEEDS THE BASIC AMBULATION SKILLS, EXHIBITING                                                                                                                                                                                                                                       
   K4003008HIGH IMPACT, STRESS, OR ENERGY LEVELS, TYPICAL OF THE PROSTHETIC DEMANDS OF THE                                                                                                                                                                                                                                      
   K4004008CHILD, ACTIVE ADULT, OR ATHLETE.                                                                                                                                                                                                                                                                                     
   KA001007ADD ON OPTION/ACCESSORY FOR WHEELCHAIR                                          Wheelchair add-on option/acc                                                                                                              C                                     01994010119970101        N                           
   KB001007BENEFICIARY REQUESTED UPGRADE FOR ABN, MORE THAN 4 MODIFIERS IDENTIFIED ON CLAIM>4 modifiers on claim                                                                                                                     C                                     02003010120030101        N                           
   KC001007REPLACEMENT OF SPECIAL POWER WHEELCHAIR INTERFACE                               Repl special pwr wc intrface                                                                                                              C                                     02005010120050101        N                           
   KD001007DRUG OR BIOLOGICAL INFUSED THROUGH DME                                          Drug/biological DME infused                                                                                                               C                                     02004010120040101        N                           
   KF001007ITEM DESIGNATED BY FDA AS CLASS III DEVICE                                      FDA class III device                                                                                                                      C                                     02004040120040401        N                           
   KH001007DMEPOS ITEM, INITIAL CLAIM, PURCHASE OR FIRST MONTH RENTAL                      DMEPOS ini clm, pur/1 mo rnt                                                                                                              C                                     01994010119970101        N                           
   KI001007DMEPOS ITEM, SECOND OR THIRD MONTH RENTAL                                       DMEPOS 2nd or 3rd mo rental                                                                                                               C                                     01994010119970101        N                           
   KJ001007DMEPOS ITEM, PARENTERAL ENTERAL NUTRITION (PEN) PUMP OR CAPPED RENTAL, MONTHS   DMEPOS PEN pmp or 4-15mo rnt                                                                                                              C                                     01994010119970101        N                           
   KJ002008FOUR TO FIFTEEN                                                                                                                                                                                                                                                                                                      
   KM001007REPLACEMENT OF FACIAL PROSTHESIS INCLUDING NEW IMPRESSION/MOULAGE               Rplc facial prosth new imp                                                                                                                C                                     01996010120010101        N                           
   KN001007REPLACEMENT OF FACIAL PROSTHESIS USING PREVIOUS MASTER MODEL                    Rplc facial prosth old mod                                                                                                                C                                     01996010120010101        N                           
   KO001007SINGLE DRUG UNIT DOSE FORMULATION                                               Single drug unit dose form                                                                                                                C                                     01997040119970401        N                           
   KP001007FIRST DRUG OF A MULTIPLE DRUG UNIT DOSE FORMULATION                             First drug of multi drug u d                                                                                                              C                                     01997040119970401        N                           
   KQ001007SECOND OR SUBSEQUENT DRUG OF A MULTIPLE DRUG UNIT DOSE FORMULATION              2nd/subsqnt drg multi drg ud                                                                                                              C                                     01997040119970401        N                           
   KR001007RENTAL ITEM, BILLING FOR PARTIAL MONTH                                          Rental item partial month                                                                                                                 C                                     02002010120020101        N                           
   KS001007GLUCOSE MONITOR SUPPLY FOR DIABETIC BENEFICIARY NOT TREATED WITH INSULIN        Glucose monitor supply                                                                                                                    D                      0074           01998100119981001        N                           
   KX001007SPECIFIC REQUIRED DOCUMENTATION ON FILE                                         Documentation on file                                                                                                                     C                                     02002070120020701        N                           
   KZ001007NEW COVERAGE NOT IMPLEMENTED BY MANAGED CARE                                    New cov not implement by m+c                                                                                                              C                                     02003100120031001        N                           
   LC001007LEFT CIRCUMFLEX CORONARY ARTERY                                                 Lft circum coronary artery                                                                                                                C                                     01997010119970101        N                           
   LD001007LEFT ANTERIOR DESCENDING CORONARY ARTERY                                        Left ant des coronary artery                                                                                                              C                                     01997010119970101        N                           
   LL001007LEASE/RENTAL (USE THE 'LL' MODIFIER WHEN DME EQUIPMENT RENTAL IS TO BE APPLIED  Lease/rental (appld to pur)                                                                                                               C                                     01984010119970101        N                           
   LL002008AGAINST THE PURCHASE PRICE)                                                                                                                                                                                                                                                                                          
   LR001007LABORATORY ROUND TRIP                                                           Laboratory round trip                                                                                                                     C                                     01987010119970101        N                           
   LS001007FDA-MONITORED INTRAOCULAR LENS IMPLANT                                          FDA-monitored IOL implant            65-7                                                                                                 D                                     01991010119970101        N                           
   LT001007LEFT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE LEFT SIDE OF THE BODY)  Left side                                                                                                                                 C                                     01984010119970101        N                           
   MS001007SIX MONTH MAINTENANCE AND SERVICING FEE FOR REASONABLE AND NECESSARY PARTS AND  6-mo maint/svc fee parts/lbr                                                                                                              C                                     01989010119970101        N                           
   MS002008LABOR WHICH ARE NOT COVERED UNDER ANY MANUFACTURER OR SUPPLIER WARRANTY                                                                                                                                                                                                                                              
   NR001007NEW WHEN RENTED (USE THE 'NR' MODIFIER WHEN DME WHICH WAS NEW AT THE TIME OF    New when rented                                                                                                                           C                                     01984010119970101        N                           
   NR002008RENTAL IS SUBSEQUENTLY PURCHASED)                                                                                                                                                                                                                                                                                    
   NU001007NEW EQUIPMENT                                                                   New equipment                                                                                                                             C                                     01984010119970101        N                           
   P1001007A NORMAL HEALTHY PATIENT                                                        Normal healthy patient                                                                                                                    C                                     02006010120060101        A                           
   P2001007A PATIENT WITH MILD SYSTEMIC DISEASE                                            Patient w/mild syst disease                                                                                                               C                                     02006010120060101        A                           
   P3001007A PATIENT WITH SEVERE SYSTEMIC DISEASE                                          Patient w/severe sys disease                                                                                                              C                                     02006010120060101        A                           
   P4001007A PATIENT WITH SEVERE SYSTEMIC DISEASE THAT IS A CONSTANT THREAT TO LIFE        Pt w/sev sys dis threat life                                                                                                              C                                     02006010120060101        A                           
   P5001007A MORIBUND PATIENT WHO IS NOT EXPECTED TO SURVIVE WITHOUT THE OPERATION         Pt not expect surv w/o oper                                                                                                               C                                     02006010120060101        A                           
   P6001007A DECLARED BRAIN-DEAD PATIENT WHOSE ORGANS ARE BEING REMOVED FOR DONOR PURPOSES Brain-dead pt organs removed                                                                                                              C                                     02006010120060101        A                           
   PL001007PROGRESSIVE ADDITION LENSES                                                     Progressive addition lenses                                                                                                               C                                     01989010119970101        N                           
   Q2001007HCFA/ORD DEMONSTRATION PROJECT PROCEDURE/SERVICE                                HCFA/ORD demo procedure/svc                                                                                                               C                      0046           01992010119970101        N                           
   Q3001007LIVE KIDNEY DONOR SURGERY AND RELATED SERVICES                                  Liver donor surgery/services                                                                                                              C                                     01995010120030101        N                           
   Q4001007SERVICE FOR ORDERING/REFERRING PHYSICIAN QUALIFIES AS A SERVICE EXEMPTION       Svc exempt - ordrg/rfrng MD                                                                                                               C                                     01994010119970101        N                           
   Q5001007SERVICE FURNISHED BY A SUBSTITUTE PHYSICIAN UNDER A RECIPROCAL BILLING          Subst MD svc, recip bill arr                           3060.6                                                                             D                                     01993010119970101        N                           
   Q5002008ARRANGEMENT                                                                                                                                                                                                                                                                                                          
   Q6001007SERVICE FURNISHED BY A LOCUM TENENS PHYSICIAN                                   Locum tenens MD service                                3060.7                                                                             D                                     01993010119970101        N                           
   Q7001007ONE CLASS A FINDING                                                             One Class A finding                                                                                                                       C                                     01995010119970101        N                           
   Q8001007TWO CLASS B FINDINGS                                                            Two Class B findings                                                                                                                      C                                     01995010119970101        N                           
   Q9001007ONE CLASS B AND TWO CLASS C FINDINGS                                            1 Class B & 2 Class C fndngs                                                                                                              C                                     01995010119970101        N                           
   QA001007FDA INVESTIGATIONAL DEVICE EXEMPTION                                            FDA investigational device                                                                                                                C                                     01996010119961001        N                           
   QB001007PHYSICIAN PROVIDING SERVICE IN A RURAL HPSA                                     MD prvdg svc in rural HPSA                             3350.3                                                                             D                      0069           0199201012006010120051231D                           
   QC001007SINGLE CHANNEL MONITORING                                                       Single channel monitoring                                                                                                                 C                                     01989010119970101        N                           
   QD001007RECORDING AND STORAGE IN SOLID STATE MEMORY BY A DIGITAL RECORDER               Rcrdg/strg in sld st memory                                                                                                               C                                     01989010119970101        N                           
   QE001007PRESCRIBED AMOUNT OF OXYGEN IS LESS THAN 1 LITER PER MINUTE (LPM)               Prescribed oxygen < 1 LPM                                                                                                                 C                                     01989010119970101        N                           
   QF001007PRESCRIBED AMOUNT OF OXYGEN EXCEEDS 4 LITERS PER MINUTE (LPM) AND PORTABLE      Prscrbd oxygen >4 LPM & port                                                                                                              C                                     01989010119970101        N                           
   QF002008OXYGEN IS PRESCRIBED                                                                                                                                                                                                                                                                                                 
   QG001007PRESCRIBED AMOUNT OF OXYGEN IS GREATER THAN 4 LITERS PER MINUTE(LPM)            Prescribed oxygen > 4 LPM                                                                                                                 C                                     01989010119970101        N                           
   QH001007OXYGEN CONSERVING DEVICE IS BEING USED WITH AN OXYGEN DELIVERY SYSTEM           Oxygen cnsrvg dvc w del sys                                                                                                               C                                     01989010119970101        N                           
   QJ001007SERVICES/ITEMS PROVIDED TO A PRISONER OR PATIENT IN STATE OR LOCAL CUSTODY,     Patient in state/locl custod                                                                                                              D                      0111           02003010120030101        N                           
   QJ002008HOWEVER THE STATE OR LOCAL GOVERNMENT, AS APPLICABLE, MEETS THE REQUIREMENTS IN                                                                                                                                                                                                                                      
   QJ00300842 CFR 411.4 (B)                                                                                                                                                                                                                                                                                                     
   QK001007MEDICAL DIRECTION OF TWO, THREE, OR FOUR CONCURRENT ANESTHESIA PROCEDURES       Med dir 2-4 cncrnt anes proc                           3350.5                                                                             D                                     01995010120010101        N                           
   QK002008INVOLVING QUALIFIED INDIVIDUALS                                                                                                                                                                                                                                                                                      
   QL001007PATIENT PRONOUNCED DEAD AFTER AMBULANCE CALLED                                  Patient died after amb call                                                                                                               C                                     01999010119990101        N                           
   QM001007AMBULANCE SERVICE PROVIDED UNDER ARRANGEMENT BY A PROVIDER OF SERVICES          Ambulance arr by provider                                                                                                                 C                                     01996010119990101        N                           
   QN001007AMBULANCE SERVICE FURNISHED DIRECTLY BY A PROVIDER OF SERVICES                  Ambulance furn by provider                                                                                                                C                                     01996010119990101        N                           
   QP001007DOCUMENTATION IS ON FILE SHOWING THAT THE LABORATORY TEST(S) WAS ORDERED        Individually ordered lab tst                           7517.1                                                                             D                                     01996010119960301        N                           
   QP002008INDIVIDUALLY OR ORDERED AS A CPT-RECOGNIZED PANEL OTHER THAN AUTOMATED PROFILE                                                                                                                                                                                                                                       
   QP003008CODES 80002-80019, G0058, G0059, AND G0060.                                                                                                                                                                                                                                                                          
   QQ001007CLAIM SUBMITTED WITH A WRITTEN STATEMENT OF INTENT                              SOI submitted                                                                                                                             C                                     0200010012006010120051231D                           
   QR001007ITEM OR SERVICE PROVIDED IN A MEDICARE SPECIFIED STUDY                          Item/serv in medicare study                                                                                                               D                      0122           02005010120050101        A                           
   QS001007MONITORED ANESTHESIA CARE SERVICE                                               Monitored anesthesia care            15018I                                                                                               D                                     01990010119960701        N                           
   QT001007RECORDING AND STORAGE ON TAPE BY AN ANALOG TAPE RECORDER                        Rcrdg/strg tape analog recdr                                                                                                              C                                     01989010119970101        N                           
   QU001007PHYSICIAN PROVIDING SERVICE IN AN URBAN HPSA                                    MD providing svc urban HPSA                            3350.3                                                                             D                      0069           0199101012006010120051231D                           
   QV001007ITEM OR SERVICE PROVIDED AS ROUTINE CARE IN A MEDICARE QUALIFYING CLINICAL TRIALItem or service provided             30-1                                                                                                 D                                     02000091920000919        N                           
   QW001007CLIA WAIVED TEST                                                                CLIA waived test                                                                                                                          C                                     01996010119961001        N                           
   QX001007CRNA SERVICE: WITH MEDICAL DIRECTION BY A PHYSICIAN                             CRNA svc w/ MD med direction                                                                                                              C                                     01993010119970101        N                           
   QY001007MEDICAL DIRECTION OF ONE CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) BY AN    Medically directed CRNA                                3350.5                                                                             D                                     01998010120010101        N                           
   QY002008ANESTHESIOLOGIST                                                                                                                                                                                                                                                                                                     
   QZ001007CRNA SERVICE: WITHOUT MEDICAL DIRECTION BY A PHYSICIAN                          CRNA svc w/o med dir by MD                                                                                                                C                                     01993010119970101        N                           
   RC001007RIGHT CORONARY ARTERY                                                           Right coronary artery                                                                                                                     C                                     01997010119970101        N                           
   RD001007DRUG PROVIDED TO BENEFICIARY, BUT NOT ADMINISTERED "INCIDENT-TO"                Drug admin not incident-to                                                                                                                C                                     02004010120040101        N                           
   RP001007REPLACEMENT AND REPAIR -RP MAY BE USED TO INDICATE REPLACEMENT OF DME, ORTHOTIC Replacement & repair(DMEPOS)                                                                                                              C                                     01984010119970101        N                           
   RP002008AND PROSTHETIC DEVICES WHICH HAVE BEEN IN USE FOR SOMETIME.  THE CLAIM SHOWS                                                                                                                                                                                                                                         
   RP003008THE CODE FOR THE PART, FOLLOWED BY THE 'RP' MODIFIER AND THE CHARGE FOR THE                                                                                                                                                                                                                                          
   RP004008PART.                                                                                                                                                                                                                                                                                                                
   RR001007RENTAL (USE THE 'RR' MODIFIER WHEN DME IS TO BE RENTED)                         Rental (DME)                                                                                                                              C                                     01984010119970101        N                           
   RT001007RIGHT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE RIGHT SIDE OF THE BODY)Right side                                                                                                                                C                                     01984010119970101        N                           
   SA001007NURSE PRACTITIONER RENDERING SERVICE IN COLLABORATION WITH A PHYSICIAN          Nurse practitioner w physici                                                                                                              I                                     02001070120010701        N                           
   SB001007NURSE MIDWIFE                                                                   Nurse midwife                                                                                                                             I                                     02001070120010701        N                           
   SC001007MEDICALLY NECESSARY SERVICE OR SUPPLY                                           Medically necessary serv/sup                                                                                                              I                                     02001070120010701        N                           
   SD001007SERVICES PROVIDED BY REGISTERED NURSE WITH SPECIALIZED, HIGHLY TECHNICAL HOME   Serv by home infusion RN                                                                                                                  I                                     02001070120010701        N                           
   SD002008INFUSION TRAINING                                                                                                                                                                                                                                                                                                    
   SE001007STATE AND/OR FEDERALLY-FUNDED PROGRAMS/SERVICES                                 State/fed funded program/ser                                                                                                              I                                     02001070120010701        N                           
   SF001007SECOND OPINION ORDERED BY A PROFESSIONAL REVIEW ORGANIZATION (PRO) PER SECTION  2nd opinion ordered by PRO                                                                                                                C                                     01987010119970101        N                           
   SF0020089401, P.L. 99-272 (100% REIMBURSEMENT - NO MEDICARE DEDUCTIBLE OR COINSURANCE)                                                                                                                                                                                                                                       
   SG001007AMBULATORY SURGICAL CENTER (ASC) FACILITY SERVICE                               ASC facility service                                                                                                                      C                                     01992010119970101        N                           
   SH001007SECOND CONCURRENTLY ADMINISTERED INFUSION THERAPY                               2nd concurrent infusion ther                                                                                                              I                                     02001070120010701        N                           
   SJ001007THIRD OR MORE CONCURRENTLY ADMINISTERED INFUSION THERAPY                        3rd concurrent infusion ther                                                                                                              I                                     02001070120010701        N                           
   SK001007MEMBER OF HIGH RISK POPULATION (USE ONLY WITH CODES FOR IMMUNIZATION)           High risk population                                                                                                                      I                                     02002040120020401        N                           
   SL001007STATE SUPPLIED VACCINE                                                          State supplied vaccine                                                                                                                    I                                     02002040120020401        N                           
   SM001007SECOND SURGICAL OPINION                                                         Second opinion                                                                                                                            I                                     02002070120020701        N                           
   SN001007THIRD SURGICAL OPINION                                                          Third opinion                                                                                                                             I                                     02002070120020701        N                           
   SQ001007ITEM ORDERED BY HOME HEALTH                                                     Item ordered by home health                                                                                                               I                                     02002100120021001        N                           
   SS001007HOME INFUSION SERVICES PROVIDED IN THE INFUSION SUITE OF THE IV THERAPY PROVIDERHIT in infusion suite                                                                                                                     I                                     02004100120041001        N                           
   ST001007RELATED TO TRAUMA OR INJURY                                                     Related to trauma or injury                                                                                                               I                                     02003010120030101        N                           
   SU001007PROCEDURE PERFORMED IN PHYSICIAN'S OFFICE (TO DENOTE USE OF FACILITY AND        Performed in phys office                                                                                                                  I                                     02003010120030101        N                           
   SU002008EQUIPMENT)                                                                                                                                                                                                                                                                                                           
   SV001007PHARMACEUTICALS DELIVERED TO PATIENT'S HOME BUT NOT UTILIZED                    Drugs delivered not used                                                                                                                  I                                     02003010120030101        N                           
   SW001007SERVICES PROVIDED BY A CERTIFIED DIABETIC EDUCATOR                              Serv by cert diab educator                                                                                                                C                                     02004040120040401        N                           
   SY001007PERSONS WHO ARE IN CLOSE CONTACT WITH MEMBER OF HIGH-RISK POPULATION (USE ONLY  Contact w/high-risk pop                                                                                                                   I                                     02005010120050101        N                           
   SY002008WITH CODES FOR IMMUNIZATION)                                                                                                                                                                                                                                                                                         
   T1001007LEFT FOOT, SECOND DIGIT                                                         Left foot, second digit                                                                                                                   C                                     01995010119990101        N                           
   T2001007LEFT FOOT, THIRD DIGIT                                                          Left foot, third digit                                                                                                                    C                                     01995010119990101        N                           
   T3001007LEFT FOOT, FOURTH DIGIT                                                         Left foot, fourth digit                                                                                                                   C                                     01995010119990101        N                           
   T4001007LEFT FOOT, FIFTH DIGIT                                                          Left foot, fifth digit                                                                                                                    C                                     01995010119990101        N                           
   T5001007RIGHT FOOT, GREAT TOE                                                           Right foot, great toe                                                                                                                     C                                     01995010119990101        N                           
   T6001007RIGHT FOOT, SECOND DIGIT                                                        Right foot, second digit                                                                                                                  C                                     01995010119990101        N                           
   T7001007RIGHT FOOT, THIRD DIGIT                                                         Right foot, third digit                                                                                                                   C                                     01995010119990101        N                           
   T8001007RIGHT FOOT, FOURTH DIGIT                                                        Right foot, fourth digit                                                                                                                  C                                     01995010119990101        N                           
   T9001007RIGHT FOOT, FIFTH DIGIT                                                         Right foot, fifth digit                                                                                                                   C                                     01995010119990101        N                           
   TA001007LEFT FOOT, GREAT TOE                                                            Left foot, great toe                                                                                                                      C                                     01995010119990101        N                           
   TC001007TECHNICAL COMPONENT.  UNDER CERTAIN CIRCUMSTANCES, A CHARGE MAY BE MADE FOR THE Technical component                                                                                                                       C                                     01984010119970101        N                           
   TC002008TECHNICAL COMPONENT ALONE.  UNDER THOSE CIRCUMSTANCES THE TECHNICAL COMPONENT                                                                                                                                                                                                                                        
   TC003008CHARGE IS IDENTIFIED BY ADDING MODIFIER 'TC' TO THE USUAL PROCEDURE NUMBER.                                                                                                                                                                                                                                          
   TC004008TECHNICAL COMPONENT CHARGES ARE INSTITUTIONAL CHARGES AND NOT BILLED SEPARATELY                                                                                                                                                                                                                                      
   TC005008BY PHYSICIANS.  HOWEVER, PORTABLE X-RAY SUPPLIERS ONLY BILL FOR TECHNICAL                                                                                                                                                                                                                                            
   TC006008COMPONENT AND SHOULD UTILIZE MODIFIER TC.  THE CHARGE DATA FROM PORTABLE X-RAY                                                                                                                                                                                                                                       
   TC007008SUPPLIERS WILL THEN BE USED TO BUILD CUSTOMARY AND PREVAILING PROFILES.                                                                                                                                                                                                                                              
   TD001007RN                                                                              RN                                                                                                                                        I                                     02001070120010701        N                           
   TE001007LPN/LVN                                                                         LPN/LVN                                                                                                                                   I                                     02001070120010701        N                           
   TF001007INTERMEDIATE LEVEL OF CARE                                                      Intermediate level of care                                                                                                                I                                     02001070120010701        N                           
   TG001007COMPLEX/HIGH TECH LEVEL OF CARE                                                 Complex/High Tech level care                                                                                                              I                                     02001070120010701        N                           
   TH001007OBSTETRICAL TREATMENT/SERVICES, PRENATAL OR POSTPARTUM                          OB TX/Srvcs prenatl/postpart                                                                                                              I                                     02001070120010701        N                           
   TJ001007PROGRAM GROUP, CHILD AND/OR ADOLESCENT                                          Child/adolescent program gp                                                                                                               I                                     02001070120010701        N                           
   TK001007EXTRA PATIENT OR PASSENGER, NON-AMBULANCE                                       Extra patient or passenger                                                                                                                I                                     02002040120020401        N                           
   TL001007EARLY INTERVENTION/INDIVIDUALIZED FAMILY SERVICE PLAN (IFSP)                    Early intervention IFSP                                                                                                                   I                                     02002040120020401        N                           
   TM001007INDIVIDUALIZED EDUCATION PROGRAM (IEP)                                          Individualized ed prgrm(IEP)                                                                                                              I                                     02002040120020401        N                           
   TN001007RURAL/OUTSIDE PROVIDERS' CUSTOMARY SERVICE AREA                                 Rural/out of service area                                                                                                                 I                                     02002040120020401        N                           
   TP001007MEDICAL TRANSPORT, UNLOADED VEHICLE	                                            Med transprt unloaded vehicl                                                                                                              I                                     02002040120020401        N                           
   TQ001007BASIC LIFE SUPPORT TRANSPORT BY A VOLUNTEER AMBULANCE PROVIDER                  BLS by volunteer amb providr                                                                                                              I                                     02002040120020401        N                           
   TR001007SCHOOL-BASED INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES PROVIDED OUTSIDE   School-based IEP out of dist                                                                                                              I                                     02002070120020701        N                           
   TR002008THE PUBLIC SCHOOL DISTRICT RESPONSIBLE FOR THE STUDENT                                                                                                                                                                                                                                                               
   TS001007FOLLOW-UP SERVICE                                                               Follow-up service                                                                                                                         C                                     02002100120060101        F                           
   TT001007INDIVIDUALIZED SERVICE PROVIDED TO MORE THAN ONE PATIENT IN SAME SETTING        Additional patient                                                                                                                        I                                     02002100120021001        N                           
   TU001007SPECIAL PAYMENT RATE, OVERTIME                                                  Overtime payment rate                                                                                                                     I                                     02003010120030101        N                           
   TV001007SPECIAL PAYMENT RATES, HOLIDAYS/WEEKENDS                                        Holiday/weekend payment rate                                                                                                              I                                     02003010120030101        N                           
   TW001007BACK-UP EQUIPMENT                                                               Back-up equipment                                                                                                                         I                                     02003010120030101        N                           
   U1001007MEDICAID LEVEL OF CARE 1, AS DEFINED BY EACH STATE                              M/caid care lev 1 state def                                                                                                               I                                     02002070120020701        N                           
   U2001007MEDICAID LEVEL OF CARE 2, AS DEFINED BY EACH STATE                              M/caid care lev 2 state def                                                                                                               I                                     02002070120020701        N                           
   U3001007MEDICAID LEVEL OF CARE 3, AS DEFINED BY EACH STATE                              M/caid care lev 3 state def                                                                                                               I                                     02002070120020701        N                           
   U4001007MEDICAID LEVEL OF CARE 4, AS DEFINED BY EACH STATE                              M/caid care lev 4 state def                                                                                                               I                                     02002070120020701        N                           
   U5001007MEDICAID LEVEL OF CARE 5, AS DEFINED BY EACH STATE                              M/caid care lev 5 state def                                                                                                               I                                     02002070120020701        N                           
   U6001007MEDICAID LEVEL OF CARE 6, AS DEFINED BY EACH STATE                              M/caid care lev 6 state def                                                                                                               I                                     02002070120020701        N                           
   U7001007MEDICAID LEVEL OF CARE 7, AS DEFINED BY EACH STATE                              M/caid care lev 7 state def                                                                                                               I                                     02002070120020701        N                           
   U8001007MEDICAID LEVEL OF CARE 8, AS DEFINED BY EACH STATE                              M/caid care lev 8 state def                                                                                                               I                                     02002070120020701        N                           
   U9001007MEDICAID LEVEL OF CARE 9, AS DEFINED BY EACH STATE                              M/caid care lev 9 state def                                                                                                               I                                     02002070120020701        N                           
   UA001007MEDICAID LEVEL OF CARE 10, AS DEFINED BY EACH STATE                             M/caid care lev 10 state def                                                                                                              I                                     02002070120020701        N                           
   UB001007MEDICAID LEVEL OF CARE 11, AS DEFINED BY EACH STATE                             M/caid care lev 11 state def                                                                                                              I                                     02002070120020701        N                           
   UC001007MEDICAID LEVEL OF CARE 12, AS DEFINED BY EACH STATE                             M/caid care lev 12 state def                                                                                                              I                                     02002070120020701        N                           
   UD001007MEDICAID LEVEL OF CARE 13, AS DEFINED BY EACH STATE                             M/caid care lev 13 state def                                                                                                              I                                     02002070120020701        N                           
   UE001007USED DURABLE MEDICAL EQUIPMENT                                                  Used durable med equipment                                                                                                                C                                     01984010119970101        N                           
   UF001007SERVICES PROVIDED IN THE MORNING                                                Services provided, morning                                                                                                                I                                     02003040120030401        N                           
   UG001007SERVICES PROVIDED IN THE AFTERNOON                                              Services provided, afternoon                                                                                                              I                                     02003040120030401        N                           
   UH001007SERVICES PROVIDED IN THE EVENING                                                Services provided, evening                                                                                                                I                                     02003040120030401        N                           
   UJ001007SERVICES PROVIDED AT NIGHT                                                      Services provided, night                                                                                                                  I                                     02003040120030401        N                           
   UK001007SERVICES PROVIDED ON BEHALF OF THE CLIENT TO SOMEONE OTHER THAN THE CLIENT      Svc on behalf client-collat                                                                                                               I                                     02003040120030401        N                           
   UK002008(COLLATERAL RELATIONSHIP)                                                                                                                                                                                                                                                                                            
   UN001007TWO PATIENTS SERVED                                                             Two patients served                                                                                                                       C                      0114           02004010120040101        N                           
   UP001007THREE PATIENTS SERVED                                                           Three patients served                                                                                                                     C                      0114           02004010120040101        N                           
   UQ001007FOUR PATIENTS SERVED                                                            Four patients served                                                                                                                      C                      0114           02004010120040101        N                           
   UR001007FIVE PATIENTS SERVED                                                            Five patients served                                                                                                                      C                      0114           02004010120040101        N                           
   US001007SIX OR MORE PATIENTS SERVED                                                     Six or more patients served                                                                                                               C                      0114           02004010120040101        N                           
   VP001007APHAKIC PATIENT                                                                 Aphakic patient                                                                                                                           C                                     01984010119970101        N                           
A0021001003AMBULANCE SERVICE, OUTSIDE STATE PER MILE, TRANSPORT (MEDICAID ONLY)            Outside state ambulance serv00      9                                                                            A0030                    I                          O1A D      01985010119960910        N                           
A0080001003NON-EMERGENCY TRANSPORTATION, PER MILE - VEHICLE PROVIDED BY VOLUNTEER          Noninterest escort in non er00      9                                                                                                     I                          O1A D      01982010120030101        N                           
A0080002004(INDIVIDUAL OR ORGANIZATION), WITH NO VESTED INTEREST                                                                                                                                                                                                                                                                
A0090001003NON-EMERGENCY TRANSPORTATION, PER MILE - VEHICLE PROVIDED BY INDIVIDUAL (FAMILY Interest escort in non er   00      9                                                                                                     I                          O1A D      01982010120030101        N                           
A0090002004MEMBER, SELF, NEIGHBOR) WITH VESTED INTEREST                                                                                                                                                                                                                                                                         
A0100001003NON-EMERGENCY TRANSPORTATION; TAXI                                              Nonemergency transport taxi 00      9                                                                                                     I                          O1A D      01982010120030101        N                           
A0110001003NON-EMERGENCY TRANSPORTATION AND BUS, INTRA OR INTER STATE CARRIER              Nonemergency transport bus  00      9                                                                                                     I                          O1A D      01984010119950101        N                           
A0120001003NON-EMERGENCY TRANSPORTATION: MINI-BUS, MOUNTAIN AREA TRANSPORTS, OR OTHER      Noner transport mini-bus    00      9                                                                                                     I                          O1A D      01982010120030101        N                           
A0120002004TRANSPORTATION SYSTEMS                                                                                                                                                                                                                                                                                               
A0130001003NON-EMERGENCY TRANSPORTATION: WHEEL-CHAIR VAN                                   Noner transport wheelch van 00      9                                                                                                     I                          O1A D      01982010119950101        N                           
A0140001003NON-EMERGENCY TRANSPORTATION AND AIR TRAVEL (PRIVATE OR COMMERCIAL) INTRA OR    Nonemergency transport air  00      9                                                                                                     I                          O1A D      01985010119960910        N                           
A0140002004INTER STATE                                                                                                                                                                                                                                                                                                          
A0160001003NON-EMERGENCY TRANSPORTATION: PER MILE - CASE WORKER OR SOCIAL WORKER           Noner transport case worker 00      9                                                                                                     I                          O1A D      01984010119950101        N                           
A0170001003TRANSPORTATION ANCILLARY:  PARKING FEES, TOLLS, OTHER                           Transport parking fees/tolls00      9                                                                                                     I                          O1A D      01982010120030101        N                           
A0180001003NON-EMERGENCY TRANSPORTATION: ANCILLARY:  LODGING-RECIPIENT                     Noner transport lodgng recip00      9                                                                                                     I                          O1A D      01982010119950101        N                           
A0190001003NON-EMERGENCY TRANSPORTATION: ANCILLARY:  MEALS-RECIPIENT                       Noner transport meals recip 00      9                                                                                                     I                          O1A D      01984010119950101        N                           
A0200001003NON-EMERGENCY TRANSPORTATION: ANCILLARY:  LODGING ESCORT                        Noner transport lodgng escrt00      9                                                                                                     I                          O1A D      01982010119950101        N                           
A0210001003NON-EMERGENCY TRANSPORTATION: ANCILLARY:  MEALS-ESCORT                          Noner transport meals escort00      9                                                                                                     I                          O1A D      01984010119950101        N                           
A0225001003AMBULANCE SERVICE, NEONATAL TRANSPORT, BASE RATE, EMERGENCY TRANSPORT, ONE WAY  Neonatal emergency transport00      9                                                                                                     I                          O1A D      01985010120030401        N                           
A0380001003BLS MILEAGE (PER MILE)                                                          Basic life support mileage  00      9                                                                            A0425                    I                          O1A D      01995010120030101        N                           
A0382001003BLS ROUTINE DISPOSABLE SUPPLIES                                                 Basic support routine suppls52      A                                                                                                     C                          O1A D      01995010119950101        N                           
A0384001003BLS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; DEFIBRILLATION (USED BY ALS        Bls defibrillation supplies 52      A                                                                                                     C                          O1A D      01995010119950101        N                           
A0384002004AMBULANCES AND BLS AMBULANCES IN JURISDICTIONS WHERE DEFIBRILLATION IS                                                                                                                                                                                                                                               
A0384003004PERMITTED IN BLS AMBULANCES)                                                                                                                                                                                                                                                                                         
A0390001003ALS MILEAGE (PER MILE)                                                          Advanced life support mileag00      9                                                                            A0425                    I                          O1A D      01995010120030101        N                           
A0392001003ALS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; DEFIBRILLATION (TO BE USED ONLY IN Als defibrillation supplies 52      A                                                                                                     C                          O1A D      01995010119950101        N                           
A0392002004JURISDICTIONS WHERE DEFIBRILLATION CANNOT BE PERFORMED IN BLS AMBULANCES)                                                                                                                                                                                                                                            
A0394001003ALS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; IV DRUG THERAPY                    Als IV drug therapy supplies52      A                                                                                                     C                          O1A D      01995010119950101        N                           
A0396001003ALS SPECIALIZED SERVICE DISPOSABLE SUPPLIES; ESOPHAGEAL INTUBATION              Als esophageal intub suppls 52      A                                                                                                     C                          O1A D      01995010119950101        N                           
A0398001003ALS ROUTINE DISPOSABLE SUPPLIES                                                 Als routine disposble suppls52      A                                                                                                     C                          O1A D      01995010119950101        N                           
A0420001003AMBULANCE WAITING TIME (ALS OR BLS), ONE HALF (1/2) HOUR INCREMENTS             Ambulance waiting 1/2 hr    52      A                                                                                                     C                          O1A D      01995010119950101        N                           
A0422001003AMBULANCE (ALS OR BLS) OXYGEN AND OXYGEN SUPPLIES, LIFE SUSTAINING SITUATION    Ambulance 02 life sustaining52      A                                                                                                     C                          O1A D      01995010119950101        N                           
A0424001003EXTRA AMBULANCE ATTENDANT, GROUND (ALS OR BLS) OR AIR (FIXED OR ROTARY WINGED); Extra ambulance attendant   52      A                                                                                                     C                          O1A D      01995010120030101        N                           
A0424002004(REQUIRES MEDICAL REVIEW)                                                                                                                                                                                                                                                                                            
A0425001003GROUND MILEAGE, PER STATUTE MILE                                                Ground mileage              52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0426001003AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY TRANSPORT, LEVEL 1 (ALS Als 1                       52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A04260020041)                                                                                                                                                                                                                                                                                                                   
A0427001003AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1          ALS1-emergency              52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0427002004(ALS1-EMERGENCY)                                                                                                                                                                                                                                                                                                     
A0428001003AMBULANCE SERVICE, BASIC LIFE SUPPORT, NON-EMERGENCY TRANSPORT, (BLS)           bls                         52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0429001003AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS-EMERGENCY)      BLS-emergency               52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0430001003AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (FIXED WING)   Fixed wing air transport    52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0431001003AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (ROTARY WING)  Rotary wing air transport   52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0432001003PARAMEDIC INTERCEPT (PI), RURAL AREA, TRANSPORT FURNISHED BY A VOLUNTEER        PI volunteer ambulance co   52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0432002004AMBULANCE COMPANY WHICH IS PROHIBITED BY STATE LAW FROM BILLING THIRD PARTY                                                                                                                                                                                                                                          
A0432003004PAYERS                                                                                                                                                                                                                                                                                                               
A0433001003ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)                                          als 2                       52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0434001003SPECIALTY CARE TRANSPORT (SCT)                                                  Specialty care transport    52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0435001003FIXED WING AIR MILEAGE, PER STATUTE MILE                                        Fixed wing air mileage      52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0436001003ROTARY WING AIR MILEAGE, PER STATUTE MILE                                       Rotary wing air mileage     52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0800001003AMBULANCE TRANSPORT PROVIDED BETWEEN THE HOURS OF 7PM AND 7AM                   Amb trans 7pm-7am           52      A                                                                                                     C                          O1A D      02004010120040101        N                           
A0888001003NONCOVERED AMBULANCE MILEAGE, PER MILE (E.G., FOR MILES TRAVELED BEYOND CLOSEST Noncovered ambulance mileage00      9                  2125                                                                               M                          O1A D      01995010119950101        N                           
A0888002004APPROPRIATE FACILITY)                                                                                                                                                                                                                                                                                                
A0998001003AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT                                  Ambulance response/treatment00      9                                                                                                     I                          O1A D      02006010120060101        A                           
A0999001003UNLISTED AMBULANCE SERVICE                                                      Unlisted ambulance service  57      A                  2120.1  2125                                                                       D                          O1A D      01987010119980101        N                           
A4206001003SYRINGE WITH NEEDLE, STERILE 1CC, EACH                                          1 CC sterile syringe&needle 00      9                                                                                                     I                          D1A S      01985010120010215        N                           
A4207001003SYRINGE WITH NEEDLE, STERILE 2CC, EACH                                          2 CC sterile syringe&needle 00      9                                                                                                     I                          D1A S      01985010120031001        N                           
A4208001003SYRINGE WITH NEEDLE, STERILE 3CC, EACH                                          3 CC sterile syringe&needle 00      9                                                                                                     I                          D1A S      01985010119990401        N                           
A4209001003SYRINGE WITH NEEDLE, STERILE 5CC OR GREATER, EACH                               5+ CC sterile syringe&needle00      9                                                                                                     I                          D1A S      01985010119990401        N                           
A4210001003NEEDLE-FREE INJECTION DEVICE, EACH                                              Nonneedle injection device  00      960-9                                                                                                 M                          D1A S      01989010119960101        N                           
A4211001003SUPPLIES FOR SELF-ADMINISTERED INJECTIONS                                       Supp for self-adm injections00      9                  2049                                                                               D                          D1A S      01993010119970101        N                           
A4212001003NON-CORING NEEDLE OR STYLET WITH OR WITHOUT CATHETER                            Non coring needle or stylet 57      A                                                                                                     C                          D1A S      01993010120000101        N                           
A4213001003SYRINGE, STERILE, 20 CC OR GREATER, EACH                                        20+ CC syringe only         00      9                                                                                                     I                          D1A S      01985010119990401        N                           
A4214001003STERILE SALINE OR WATER, 30 CC VIAL                                             30 CC sterile water/saline  37      A                                                                                                     C                          D1F P      0198401012004010120031231N                           
A4215001003NEEDLE, STERILE, ANY SIZE, EACH                                                 Sterile needle              00      9                                                                                                     I                          D1A S      01985010120060101        C                           
A4216001003STERILE WATER, SALINE AND/OR DEXTROSE (DILUENT), 10 ML                          Sterile water/saline, 10 ml 37      A                  2049                                                                               D                          D1F 1LP    02004010120060101        C                           
A4217001003STERILE WATER/SALINE, 500 ML                                                    Sterile water/saline, 500 ml37      A                  2049                                                                               D                          D1F 1LP    02004010120040101        N                           
A4218001003STERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML                          Sterile saline or water     51      A                                                                                                     D                      0127O1E 1LP    02006010120060101        A                           
A4220001003REFILL KIT FOR IMPLANTABLE INFUSION PUMP                                        Infusion pump refill kit    57      A60-14                                                                                                D                      0050D1A P      01994010119980303        N                           
A4221001003SUPPLIES FOR MAINTENANCE OF DRUG INFUSION CATHETER, PER WEEK (LIST DRUG         Maint drug infus cath per wk34      A                                                                                                     C                          D1E P      01997010119970101        N                           
A4221002004SEPARATELY)                                                                                                                                                                                                                                                                                                          
A4222001003INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST    Infusion supplies with pump 34      A                                                                                                     C                          D1E P      01997010120050101        N                           
A4222002004DRUGS SEPARATELY)                                                                                                                                                                                                                                                                                                    
A4223001003INFUSION SUPPLIES NOT USED WITH EXTERNAL INFUSION PUMP, PER CASSETTE OR BAG     Infusion supplies w/o pump  00      9                                                                                                     I                          D1E P      02005010120050101        N                           
A4223002004(LIST DRUGS SEPARATELY)                                                                                                                                                                                                                                                                                              
A4230001003INFUSION SET FOR EXTERNAL INSULIN PUMP, NON NEEDLE CANNULA TYPE                 Infus insulin pump non needl34      A60-14                                                                                                D                          D1E P      01996010120000101        N                           
A4231001003INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE                             Infusion insulin pump needle34      A60-14                                                                                                D                          D1E P      01996010120000101        N                           
A4232001003SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3CC                     Syringe w/needle insulin 3cc00      960-14                                                                                                I                          D1E P      01996010120030401        N                           
A4233001003REPLACEMENT BATTERY, ALKALINE (OTHER THAN J CELL), FOR USE WITH MEDICALLY       Alkalin batt for glucose mon36      A                                                                                                     C                          D1E P      02006010120060101        A                           
A4233002004NECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                          
A4234001003REPLACEMENT BATTERY, ALKALINE, J CELL, FOR USE WITH MEDICALLY NECESSARY HOME    J-cell batt for glucose mon 36      A                                                                                                     C                          D1E P      02006010120060101        A                           
A4234002004BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                                         
A4235001003REPLACEMENT BATTERY, LITHIUM, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD       Lithium batt for glucose mon36      A                                                                                                     C                          D1E P      02006010120060101        A                           
A4235002004GLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                                               
A4236001003REPLACEMENT BATTERY, SILVER OXIDE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD  Silvr oxide batt glucose mon36      A                                                                                                     C                          D1E P      02006010120060101        A                           
A4236002004GLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                                               
A4244001003ALCOHOL OR PEROXIDE, PER PINT                                                   Alcohol or peroxide per pint00      9                                                                                                     I                          D1A LS     01985010120060101        F                           
A4245001003ALCOHOL WIPES, PER BOX                                                          Alcohol wipes per box       00      9                                                                                                     I                          D1A LS     01985010120060101        F                           
A4246001003BETADINE OR PHISOHEX SOLUTION, PER PINT                                         Betadine/phisohex solution  00      9                                                                                                     I                          D1A LS     01985010120060101        F                           
A4247001003BETADINE OR IODINE SWABS/WIPES, PER BOX                                         Betadine/iodine swabs/wipes 00      9                                                                                                     I                          D1A LS     01985010120060101        F                           
A4248001003CHLORHEXIDINE CONTAINING ANTISEPTIC, 1 ML                                       Chlorhexidine antisept      52      A                                                                                                     C                          P9B L      02004010120040101        N                           
A4250001003URINE TEST OR REAGENT STRIPS OR TABLETS (100 TABLETS OR STRIPS)                 Urine reagent strips/tablets00      9                  2100                                                                               M                          T1E 9      01990010119970101        N                           
A4253001003BLOOD GLUCOSE TEST OR REAGENT STRIPS FOR HOME BLOOD GLUCOSE MONITOR, PER 50     Blood glucose/reagent strips32      A60-11                                                                                                D                          D1E P      01986010119980701        N                           
A4253002004STRIPS                                                                                                                                                                                                                                                                                                               
A4254001003REPLACEMENT BATTERY, ANY TYPE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD      Battery for glucose monitor 32      A60-11                                                                                                D                          D1E APR    0199601012006010120051231D                           
A4254002004GLUCOSE MONITOR OWNED BY PATIENT, EACH                                                                                                                                                                                                                                                                               
A4255001003PLATFORMS FOR HOME BLOOD GLUCOSE MONITOR, 50 PER BOX                            Glucose monitor platforms   34      A60-11                                                                                                D                          D1E P      01997010120020101        N                           
A4256001003NORMAL, LOW AND HIGH CALIBRATOR SOLUTION / CHIPS                                Calibrator solution/chips   34      A60-11                                                                                                D                          D1E P      01985010120020101        N                           
A4257001003REPLACEMENT LENS SHIELD CARTRIDGE FOR USE WITH LASER SKIN PIERCING DEVICE, EACH Replace Lensshield Cartridge34      A                                                                                                     C                          D1E P      02002010120020101        N                           
A4258001003SPRING-POWERED DEVICE FOR LANCET, EACH                                          Lancet device each          34      A60-11                                                                                                D                          D1E P      01996010120020101        N                           
A4259001003LANCETS, PER BOX OF 100                                                         Lancets per box             34      A60-11                                                                                                D                          D1E P      01985010119960101        N                           
A4260001003LEVONORGESTREL (CONTRACEPTIVE) IMPLANTS SYSTEM, INCLUDING IMPLANTS AND SUPPLIES Levonorgestrel implant      00      9                                          1862a1A                           J7306                    S                          P6C 9      0199301012006010120051231D                           
A4261001003CERVICAL CAP FOR CONTRACEPTIVE USE                                              Cervical cap contraceptive  00      9                                          1862a1                                                     S                          Z2  9      01999010119990101        N                           
A4262001003TEMPORARY, ABSORBABLE LACRIMAL DUCT IMPLANT, EACH                               Temporary tear duct plug    00      9                                                                                                     D                      0052D1A 9      01994010119980101        N                           
A4263001003PERMANENT, LONG TERM, NON-DISSOLVABLE LACRIMAL DUCT IMPLANT, EACH               Permanent tear duct plug    11      A                  15030                                                                              D                          Y1  9      01994010119980101        N                           
A4265001003PARAFFIN, PER POUND                                                             Paraffin                    34      A60-9                                                                                                 D                          D1E 9      01986010120020101        N                           
A4266001003DIAPHRAGM FOR CONTRACEPTIVE USE                                                 Diaphragm                   00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
A4267001003CONTRACEPTIVE SUPPLY, CONDOM, MALE, EACH                                        Male condom                 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
A4268001003CONTRACEPTIVE SUPPLY, CONDOM, FEMALE, EACH                                      Female condom               00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
A4269001003CONTRACEPTIVE SUPPLY, SPERMICIDE (E.G., FOAM, GEL), EACH                        Spermicide                  00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
A4270001003DISPOSABLE ENDOSCOPE SHEATH, EACH                                               Disposable endoscope sheath 00      9                                                                                                     C                          P8D 9      01994010119950401        N                           
A4280001003ADHESIVE SKIN SUPPORT ATTACHMENT FOR USE WITH EXTERNAL BREAST PROSTHESIS, EACH  Brst prsths adhsv attchmnt  38      A                                                                                                     C                          D1F P      02000010120000101        N                           
A4281001003TUBING FOR BREAST PUMP, REPLACEMENT                                             Replacement breastpump tube 00      9                                                                                                     I                          Z2  9      02003010120060101        F                           
A4282001003ADAPTER FOR BREAST PUMP, REPLACEMENT                                            Replacement breastpump adpt 00      9                                                                                                     I                          Z2  9      02003010120060101        F                           
A4283001003CAP FOR BREAST PUMP BOTTLE, REPLACEMENT                                         Replacement breastpump cap  00      9                                                                                                     I                          Z2  9      02003010120060101        F                           
A4284001003BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT        Replcmnt breast pump shield 00      9                                                                                                     I                          Z2  9      02003010120060101        F                           
A4285001003POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT                      Replcmnt breast pump bottle 00      9                                                                                                     I                          Z2  9      02003010120060101        F                           
A4286001003LOCKING RING FOR BREAST PUMP, REPLACEMENT                                       Replcmnt breastpump lok ring00      9                                                                                                     I                          Z2  9      02003010120060101        F                           
A4290001003SACRAL NERVE STIMULATION TEST LEAD, EACH                                        Sacral nerve stim test lead 00      9                                                                                                     C                          Z2  9      02001010120020101        N                           
A4300001003IMPLANTABLE ACCESS CATHETER, (E,G., VENOUS, ARTERIAL, EPIDURAL SUBARACHNOID, OR Cath impl vasc access portal11      A                  2130                                                                               D                          Y1  S      01986010120020101        N                           
A4300002004PERITONEAL, ETC.) EXTERNAL ACCESS                                                                                                                                                                                                                                                                                    
A4301001003IMPLANTABLE ACCESS TOTAL CATHETER, PORT/RESERVOIR (E.G., VENOUS, ARTERIAL,      Implantable access syst perc00      9                                                                                                     C                          D1A S      01996010120030101        N                           
A4301002004EPIDURAL, SUBARACHNOID, PERITONEAL, ETC.)                                                                                                                                                                                                                                                                            
A4305001003DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 50 ML OR GREATER PER HOUR         Drug delivery system >=50 ML00      9                                                                                                     C                          D1A 9      01993010120060101        F                           
A4306001003DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 5 ML OR LESS PER HOUR             Drug delivery system <=5 ML 00      9                                                                                                     C                          D1A 9      01993010120060101        F                           
A4310001003INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CATHETER (ACCESSORIES ONLY)     Insert tray w/o bag/cath    37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4311001003INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,       Catheter w/o bag 2-way latex37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4311002004TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER OR                                                                                                                                                                                                                                                  
A4311003004HYDROPHILIC, ETC.)                                                                                                                                                                                                                                                                                                   
A4312001003INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,       Cath w/o bag 2-way silicone 37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4312002004TWO-WAY, ALL SILICONE                                                                                                                                                                                                                                                                                                
A4313001003INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,       Catheter w/bag 3-way        37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4313002004THREE-WAY, FOR CONTINUOUS IRRIGATION                                                                                                                                                                                                                                                                                 
A4314001003INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY  Cath w/drainage 2-way latex 37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4314002004LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER OR HYDROPHILIC, ETC.)                                                                                                                                                                                                                                       
A4315001003INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, Cath w/drainage 2-way silcne37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4315002004ALL SILICONE                                                                                                                                                                                                                                                                                                         
A4316001003INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,          Cath w/drainage 3-way       37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4316002004THREE-WAY, FOR CONTINUOUS IRRIGATION                                                                                                                                                                                                                                                                                 
A4319001003STERILE WATER IRRIGATION SOLUTION, 1000 ML                                      Sterile H2O irrigation solut37      A                  2130                                                                               D                          D1F P      0200101012004010120031231N                           
A4320001003IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY PURPOSE                        Irrigation tray             37      A                  2130                                                                               D                          D1A P      01990010119920101        N                           
A4321001003THERAPEUTIC AGENT FOR URINARY CATHETER IRRIGATION                               Cath therapeutic irrig agent37      A                  2130                                                                               D                          D1F P      01997010120030101        N                           
A4322001003IRRIGATION SYRINGE, BULB OR PISTON, EACH                                        Irrigation syringe          37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4323001003STERILE SALINE IRRIGATION SOLUTION, 1000 ML.                                    Saline irrigation solution  37      A                  2130                                                                               D                          D1F P      0199001012004010120031231N                           
A4324001003MALE EXTERNAL CATHETER, WITH ADHESIVE COATING, EACH                             Male ext cath w/adh coating 37      A                  2130                                                      A4349                    D                          D1F P      0200101012005010120041231N                           
A4325001003MALE EXTERNAL CATHETER, WITH ADHESIVE STRIP, EACH                               Male ext cath w/adh strip   37      A                  2130                                                      A4349                    D                          D1F P      0200101012005010120041231N                           
A4326001003MALE EXTERNAL CATHETER SPECIALTY TYPE WITH INTEGRAL COLLECTION CHAMBER,  EACH   Male external catheter      37      A                  2130                                                                               D                          D1F P      01990010120040101        N                           
A4327001003FEMALE EXTERNAL URINARY COLLECTION DEVICE; MEATAL CUP, EACH                     Fem urinary collect dev cup 37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4328001003FEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH                          Fem urinary collect pouch   37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4330001003PERIANAL FECAL COLLECTION POUCH WITH ADHESIVE, EACH                             Stool collection pouch      37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4331001003EXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, WITH CONNECTOR/ADAPTOR, FOR    Extension drainage tubing   37      A                  2130                                                                               D                          D1F P      02001010120030101        N                           
A4331002004USE WITH URINARY LEG BAG OR UROSTOMY POUCH, EACH                                                                                                                                                                                                                                                                     
A4332001003LUBRICANT, INDIVIDUAL STERILE PACKET, EACH                                      Lube sterile packet         37      A                  2130                                                                               D                          D1F P      02001010120050101        N                           
A4333001003URINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT, EACH               Urinary cath anchor device  37      A                  2130                                                                               D                          D1F P      02001010120030101        N                           
A4334001003URINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH                              Urinary cath leg strap      37      A                  2130                                                                               D                          D1F P      02001010120030101        N                           
A4335001003INCONTINENCE SUPPLY; MISCELLANEOUS                                              Incontinence supply         46      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4338001003INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE,  Indwelling catheter latex   37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4338002004SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH                                                                                                                                                                                                                                                                      
A4340001003INDWELLING CATHETER; SPECIALTY TYPE, EG; COUDE, MUSHROOM, WING, ETC.), EACH     Indwelling catheter special 37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4344001003INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE, EACH                    Cath indw foley 2 way silicn37      A                  2130                                                                               D                          D1F P      01983010119960101        N                           
A4346001003INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CONTINUOUS IRRIGATION, EACH      Cath indw foley 3 way       37      A                  2130                                                                               D                          D1F P      01983010119960101        N                           
A4347001003MALE EXTERNAL CATHETER WITH OR WITHOUT ADHESIVE, WITH OR WITHOUT ANTI-REFLUX    Male external catheter      37      A                  2130                                                                               D                          D1F P      0198301012005010120041231N                           
A4347002004DEVICE; PER DOZEN                                                                                                                                                                                                                                                                                                    
A4348001003MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION COMPARTMENT, EXTENDED WEAR,     Male ext cath extended wear 37      A                  2130                                                                               D                          D1F P      02001010120030101        N                           
A4348002004EACH (E.G., 2 PER MONTH)                                                                                                                                                                                                                                                                                             
A4349001003MALE EXTERNAL CATHETER, WITH OR WITHOUT ADHESIVE, DISPOSABLE, EACH              Disposable male external cat37      A                  2130                                                                               D                          D1A P      02005010120050101        N                           
A4351001003INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON,   Straight tip urine catheter 37      A                  2130                                                                               D                          D1F P      01990010120020101        N                           
A4351002004SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH                                                                                                                                                                                                                                                            
A4352001003INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING      Coude tip urinary catheter  37      A                  2130                                                                               D                          D1F P      01990010120020101        N                           
A4352002004(TEFLON, SILICONE, SILICONE ELASTOMERIC, OR HYDROPHILIC, ETC.), EACH                                                                                                                                                                                                                                                 
A4353001003INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES                          Intermittent urinary cath   37      A                  2130                                                                               D                          D1F P      01997010120030101        N                           
A4354001003INSERTION TRAY WITH DRAINAGE BAG BUT WITHOUT CATHETER                           Cath insertion tray w/bag   37      A                  2130                                                                               D                          D1F P      01986010119900101        N                           
A4355001003IRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIGATION THROUGH A THREE-WAY     Bladder irrigation tubing   37      A                  2130                                                                               D                          D1F P      01984010119960101        N                           
A4355002004INDWELLING FOLEY CATHETER, EACH                                                                                                                                                                                                                                                                                      
A4356001003EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE (NOT TO BE USED FOR CATHETER      Ext ureth clmp or compr dvc 37      A                  2130                                                                               D                          D1F P      01985010119960101        N                           
A4356002004CLAMP), EACH                                                                                                                                                                                                                                                                                                         
A4357001003BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOUT ANTI-REFLUX DEVICE, WITH OR Bedside drainage bag        37      A                  2130                                                                               D                          D1F P      01985010119960101        N                           
A4357002004WITHOUT TUBE, EACH                                                                                                                                                                                                                                                                                                   
A4358001003URINARY DRAINAGE BAG, LEG OR ABDOMEN, VINYL, WITH OR WITHOUT TUBE, WITH STRAPS, Urinary leg or abdomen bag  37      A                  2130                                                                               D                          D1F P      01985010120020101        N                           
A4358002004EACH                                                                                                                                                                                                                                                                                                                 
A4359001003URINARY SUSPENSORY WITHOUT LEG BAG, EACH                                        Urinary suspensory w/o leg b37      A                  2130                                                                               D                          D1F P      01985010119960101        N                           
A4360001003ADULT INCONTINENCE GARMENT (E.G. BRIEF, DIAPER), EACH                           Adult incontinence garment  00      960-9                                                                                                 M                          D1A 9      0200201012003010120021231N                           
A4361001003OSTOMY FACEPLATE, EACH                                                          Ostomy face plate           37      A                  2130                                                                               D                          D1F P      01985010119960101        N                           
A4362001003SKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH                                  Solid skin barrier          37      A                  2130                                                                               D                          D1F P      01985010119900101        N                           
A4363001003OSTOMY CLAMP, ANY TYPE, REPLACEMENT ONLY, EACH                                  Ostomy clamp, replacement   37      A                                                                                                     D                      0124D1F P      02006010120060101        A                           
A4364001003ADHESIVE, LIQUID OR EQUAL, ANY TYPE,  PER OZ                                    Adhesive, liquid or equal   37      A                  2130                                                                               D                          D1F P      01985010120030101        N                           
A4365001003ADHESIVE REMOVER WIPES, ANY TYPE, PER 50                                        Adhesive remover wipes      37      A                  2130                                                                               D                          D1F P      01997010120030101        N                           
A4366001003OSTOMY VENT, ANY TYPE, EACH                                                     Ostomy vent                 37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4367001003OSTOMY BELT, EACH                                                               Ostomy belt                 37      A                  2130A                                                                              D                          D1F P      01985010119960101        N                           
A4368001003OSTOMY FILTER, ANY TYPE, EACH                                                   Ostomy filter               37      A                                                                                                     C                          D1F P      01997010119970101        N                           
A4369001003OSTOMY SKIN BARRIER, LIQUID (SPRAY, BRUSH, ETC), PER OZ                         Skin barrier liquid per oz  37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4370001003OSTOMY SKIN BARRIER, PASTE, PER OZ                                              Skin barrier paste per oz   37      A                                                                                                     C                          D1A P      0200001012003010120021231N                           
A4371001003OSTOMY SKIN BARRIER, POWDER, PER OZ                                             Skin barrier powder per oz  37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4372001003OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT,  STANDARD WEAR, WITH BUILT-IN     Skin barrier solid 4x4 equiv37      A                  2130                                                                               D                          D1F P      02000010120060101        C                           
A4372002004CONVEXITY, EACH                                                                                                                                                                                                                                                                                                      
A4373001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDIAN),  WITH BUILT-IN Skin barrier with flange    37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4373002004CONVEXITY, ANY SIZE, EACH                                                                                                                                                                                                                                                                                            
A4374001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Skin barrier extended wear  37      A                                                                                                     C                          D1A P      0200001012003010120021231N                           
A4374002004WITH BUILT-IN CONVEXITY, ANY SIZE, EACH                                                                                                                                                                                                                                                                              
A4375001003OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, PLASTIC, EACH                 Drainable plastic pch w fcpl37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4376001003OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, RUBBER, EACH                  Drainable rubber pch w fcplt37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4377001003OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, PLASTIC, EACH                    Drainable plstic pch w/o fp 37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4378001003OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, RUBBER, EACH                     Drainable rubber pch w/o fp 37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4379001003OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, PLASTIC, EACH                   Urinary plastic pouch w fcpl37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4380001003OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RUBBER, EACH                    Urinary rubber pouch w fcplt37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4381001003OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, PLASTIC, EACH                      Urinary plastic pouch w/o fp37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4382001003OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, HEAVY PLASTIC, EACH                Urinary hvy plstc pch w/o fp37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4383001003OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, RUBBER, EACH                       Urinary rubber pouch w/o fp 37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4384001003OSTOMY FACEPLATE EQUIVALENT, SILICONE RING, EACH                                Ostomy faceplt/silicone ring37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4385001003OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITHOUT BUILT-IN   Ost skn barrier sld ext wear37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4385002004CONVEXITY, EACH                                                                                                                                                                                                                                                                                                      
A4386001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barrier w flng ex wr37      A                                                                                                     C                          D1A P      0200001012003010120021231N                           
A4386002004WITHOUT BUILT-IN CONVEXITY, ANY SIZE, EACH                                                                                                                                                                                                                                                                           
A4387001003OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE), Ost clsd pouch w att st barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4387002004EACH                                                                                                                                                                                                                                                                                                                 
A4388001003OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, (1 PIECE), EACH   Drainable pch w ex wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4389001003OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1      Drainable pch w st wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4389002004PIECE), EACH                                                                                                                                                                                                                                                                                                         
A4390001003OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN     Drainable pch ex wear convex37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4390002004CONVEXITY (1 PIECE), EACH                                                                                                                                                                                                                                                                                            
A4391001003OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED (1 PIECE), EACH      Urinary pouch w ex wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4392001003OSTOMY POUCH, URINARY, WITH STANDARD WEAR BARRIER ATTACHED, WITH BUILT-IN       Urinary pouch w st wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4392002004CONVEXITY (1 PIECE), EACH                                                                                                                                                                                                                                                                                            
A4393001003OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN       Urine pch w ex wear bar conv37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4393002004CONVEXITY (1 PIECE), EACH                                                                                                                                                                                                                                                                                            
A4394001003OSTOMY DEODORANT FOR USE IN OSTOMY POUCH, LIQUID, PER FLUID OUNCE               Ostomy pouch liq deodorant  37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4395001003OSTOMY DEODORANT FOR USE IN OSTOMY POUCH, SOLID, PER TABLET                     Ostomy pouch solid deodorant37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4396001003OSTOMY BELT WITH PERISTOMAL HERNIA SUPPORT                                      Peristomal hernia supprt blt37      A                  2130                                                                               D                          D1F P      02001010120030101        N                           
A4397001003IRRIGATION SUPPLY; SLEEVE, EACH                                                 Irrigation supply sleeve    37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4398001003OSTOMY IRRIGATION SUPPLY; BAG, EACH                                             Ostomy irrigation bag       37      A                  2130                                                                               D                          D1F P      01989010119970101        N                           
A4399001003OSTOMY IRRIGATION SUPPLY; CONE/CATHETER, INCLUDING BRUSH                        Ostomy irrig cone/cath w brs37      A                  2130                                                                               D                          D1F P      01989010119970101        N                           
A4400001003OSTOMY IRRIGATION SET                                                           Ostomy irrigation set       37      A                  2130                                                                               D                          D1F P      01982010119900101        N                           
A4402001003LUBRICANT, PER OUNCE                                                            Lubricant per ounce         37      A                  2130                                                                               D                          D1F P      01985010119950101        N                           
A4404001003OSTOMY RING, EACH                                                               Ostomy ring each            37      A                  2130                                                                               D                          D1F P      01985010119950101        N                           
A4405001003OSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE                         Nonpectin based ostomy paste37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4406001003OSTOMY SKIN BARRIER, PECTIN-BASED, PASTE, PER OUNCE                             Pectin based ostomy paste   37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4407001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE, OR ACCORDION), EXTENDED      Ext wear ost skn barr <=4sq37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4407002004WEAR, WITH BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                         
A4408001003OSTOMY SKIN BARRIER, WTIH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ext wear ost skn barr >4sq 37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4408002004WITH BUILT-IN CONVEXITY, LARGER THAN 4 X 4 INCHES, EACH                                                                                                                                                                                                                                                              
A4409001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barr convex <=4 sq i37      A                  2130                                                                               D                          D1F P      02003010120060101        S                           
A4409002004WITHOUT BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                            
A4410001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barr extnd >4 sq    37      A                  2130                                                                               D                          D1F P      02003010120060101        S                           
A4410002004WITHOUT BUILT-IN CONVEXITY, LARGER THAN 4 X 4 INCHES, EACH                                                                                                                                                                                                                                                           
A4411001003OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITH BUILT-IN      Ost skn barr extnd =4sq     37      A                                                                                                     D                      0124D1F P      02006010120060101        A                           
A4411002004CONVEXITY, EACH                                                                                                                                                                                                                                                                                                      
A4412001003OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE Ost pouch drain high output 37      A                  2130                                                                               D                      0124D1F P      02006010120060101        A                           
A4412002004SYSTEM), WITHOUT FILTER, EACH                                                                                                                                                                                                                                                                                        
A4413001003OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE 2 pc drainable ost pouch    37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4413002004SYSTEM), WITH FILTER, EACH                                                                                                                                                                                                                                                                                           
A4414001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT        Ost sknbar w/o conv<=4 sq in37      A                  2130                                                                               D                          D1F P      02003010120060101        S                           
A4414002004BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                                    
A4415001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT        Ost skn barr w/o conv >4 sqi37      A                  2130                                                                               D                          D1F P      02003010120060101        S                           
A4415002004BUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH                                                                                                                                                                                                                                                                     
A4416001003OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH        Ost pch clsd w barrier/filtr37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4417001003OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH      Ost pch w bar/bltinconv/fltr37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4417002004FILTER (1 PIECE), EACH                                                                                                                                                                                                                                                                                               
A4418001003OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH     Ost pch clsd w/o bar w filtr37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4419001003OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH FILTER   Ost pch for bar w flange/flt37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4419002004(2 PIECE), EACH                                                                                                                                                                                                                                                                                                      
A4420001003OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH    Ost pch clsd for bar w lk fl37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4421001003OSTOMY SUPPLY; MISCELLANEOUS                                                    Ostomy supply misc          00      9                                                                                                     I                          D1F P      01985010120060101        F                           
A4422001003OSTOMY ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKET) FOR USE IN OSTOMY POUCH TO Ost pouch absorbent material37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4422002004THICKEN LIQUID STOMAL OUTPUT, EACH                                                                                                                                                                                                                                                                                   
A4423001003OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2    Ost pch for bar w lk fl/fltr37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4423002004PIECE), EACH                                                                                                                                                                                                                                                                                                         
A4424001003OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH     Ost pch drain w bar & filter37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4425001003OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH       Ost pch drain for barrier fl37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4425002004FILTER (2 PIECE SYSTEM), EACH                                                                                                                                                                                                                                                                                        
A4426001003OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE        Ost pch drain 2 piece system37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4426002004SYSTEM), EACH                                                                                                                                                                                                                                                                                                        
A4427001003OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2 Ost pch drain/barr lk flng/f37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4427002004PIECE SYSTEM), EACH                                                                                                                                                                                                                                                                                                  
A4428001003OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FAUCET-TYPE    Urine ost pouch w faucet/tap37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4428002004TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                                                       
A4429001003OSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH     Urine ost pouch w bltinconv 37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4429002004FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                                           
A4430001003OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN       Ost urine pch w b/bltin conv37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4430002004CONVEXITY, WITH FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                           
A4431001003OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH VALVE   Ost pch urine w barrier/tapv37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4431002004(1 PIECE), EACH                                                                                                                                                                                                                                                                                                      
A4432001003OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH         Os pch urine w bar/fange/tap37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4432002004FAUCET-TYPE TAP WITH VALVE (2 PIECE), EACH                                                                                                                                                                                                                                                                           
A4433001003OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH   Urine ost pch bar w lock fln37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4434001003OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FAUCET-TYPE Ost pch urine w lock flng/ft37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4434002004TAP WITH VALVE (2 PIECE), EACH                                                                                                                                                                                                                                                                                       
A4450001003TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES                                      Non-waterproof tape         37      A                  2130                                                                               D                          D1F LP     02003010120030101        N                           
A4452001003TAPE, WATERPROOF, PER 18 SQUARE INCHES                                          Waterproof tape             37      A                  2130                                                                               D                          D1F LP     02003010120030101        N                           
A4454001003TAPE, ALL TYPES, ALL SIZES                                                      Tape all types all sizes    37      A                  2130                                                                               D                          D1A P      0198901012003010120021231N                           
A4455001003ADHESIVE REMOVER OR SOLVENT (FOR TAPE, CEMENT OR OTHER ADHESIVE), PER OUNCE     Adhesive remover per ounce  37      A                  2130                                                                               D                          D1F P      01989010119950101        N                           
A4458001003ENEMA BAG WITH TUBING, REUSABLE                                                 Reusable enema bag          00      9                                                                                                     I                          Z2  9      02003010120060101        F                           
A4460001003ELASTIC BANDAGE, PER ROLL (E.G. COMPRESSION BANDAGE)                            Elastic compression bandage 35      A                  2079                                                                               D                          D1A S      0198201012003010120021231N                           
A4462001003ABDOMINAL DRESSING HOLDER, EACH                                                 Abdmnl drssng holder/binder 35      A                  2079                                                                               D                          D1A S      01998010120030101        N                           
A4464001003JOINT SUPPORTIVE DEVICE/GARMENT, ELASTIC OR EQUAL, EACH                         Joint support device/garment00      9                  2303                                                                               M                          Z2  P      0200101012003010120021231N                           
A4465001003NON-ELASTIC BINDER FOR EXTREMITY                                                Non-elastic extremity binder00      9                                                                                                     C                          D1A 9      01994010119950101        N                           
A4470001003GRAVLEE JET WASHER                                                              Gravlee jet washer          00      950-4              2320                                                                               D                          D1A P      01986010120010101        N                           
A4480001003VABRA ASPIRATOR                                                                 Vabra aspirator             00      950-10             2320                                                                               D                          D1A P      01986010120010101        N                           
A4481001003TRACHEOSTOMA FILTER, ANY TYPE, ANY SIZE, EACH                                   Tracheostoma filter         37      A                  2130                                                                               D                          D1F P      01997010120030101        N                           
A4483001003MOISTURE EXCHANGER, DISPOSABLE, FOR USE WITH INVASIVE MECHANICAL VENTILATION    Moisture exchanger          37      A                  2130                                                                               D                          D1F P      01999010120030101        N                           
A4490001003SURGICAL STOCKINGS ABOVE KNEE LENGTH, EACH                                      Above knee surgical stocking00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N                           
A4495001003SURGICAL STOCKINGS THIGH LENGTH, EACH                                           Thigh length surg stocking  00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N                           
A4500001003SURGICAL STOCKINGS BELOW KNEE LENGTH, EACH                                      Below knee surgical stocking00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N                           
A4510001003SURGICAL STOCKINGS FULL LENGTH, EACH                                            Full length surg stocking   00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N                           
A4520001003INCONTINENCE GARMENT, ANY TYPE, (E.G. BRIEF, DIAPER), EACH                      Incontinence garment anytype00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
A4521001003ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, SMALL SIZE, EACH                      Adult size diaper sm each   00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4522001003ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, MEDIUM SIZE, EACH                     Adult size diaper med each  00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4523001003ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, LARGE SIZE, EACH                      Adult size diaper lg each   00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4524001003ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, EXTRA LARGE SIZE, EACH                Adult size diaper xl each   00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4525001003ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, SMALL SIZE, EACH                       Adult size brief sm each    00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4526001003ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, MEDIUM SIZE, EACH                      Adult size brief med each   00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4527001003ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, LARGE SIZE, EACH                       Adult size brief lg each    00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4528001003ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, EXTRA-LARGE SIZE, EACH                 Adult size brief xl each    00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4529001003CHILD-SIZED INCONTINENCE PRODUCT, DIAPER, SMALL/MEDIUM SIZE, EACH               Child size diaper sm/med ea 00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4530001003CHILD-SIZED INCONTINENCE PRODUCT, DIAPER, LARGE SIZE, EACH                      Child size diaper lg each   00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4531001003CHILD-SIZED INCONTINENCE PRODUCT, BRIEF, SMALL/MEDIUM SIZE, EACH                Child size brief sm/med each00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4532001003CHILD-SIZED INCONTINENCE PRODUCT, BRIEF, LARGE SIZE, EACH                       Child size brief lg each    00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4533001003YOUTH-SIZED INCONTINENCE PRODUCT, DIAPER, EACH                                  Youth size diaper each      00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4534001003YOUTH-SIZED INCONTINENCE PRODUCT, BRIEF, EACH                                   Youth size brief each       00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4535001003DISPOSABLE LINER/SHIELD FOR INCONTINENCE, EACH                                  Disp incont liner/shield ea 00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4536001003PROTECTIVE UNDERWEAR, WASHABLE, ANY SIZE, EACH                                  Prot underwr wshbl any sz ea00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4537001003UNDER PAD, REUSABLE/WASHABLE, ANY SIZE, EACH                                    Under pad reusable any sz ea00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4538001003DIAPER, REUSABLE, PROVIDED BY A DIAPER SERVICE, EACH DIAPER                     Reusable diaper from dpr svc00      960-9                                                                                                 M                          D1A 9      0200301012005010120041231N                           
A4550001003SURGICAL TRAYS                                                                  Surgical trays              11      A                  15030                                                                              D                          Y1  9      01982010120000101        N                           
A4554001003DISPOSABLE UNDERPADS, ALL SIZES                                                 Disposable underpads        00      960-9                                                                                                 M                          D1A 9      01986010120050101        F                           
A4556001003ELECTRODES, (E.G., APNEA MONITOR), PER PAIR                                     Electrodes, pair            34      A                                                                                                     C                          D1E P      01984010120000101        N                           
A4557001003LEAD WIRES, (E.G., APNEA MONITOR), PER PAIR                                     Lead wires, pair            34      A                                                                                                     C                          D1E P      01984010120000101        N                           
A4558001003CONDUCTIVE PASTE OR GEL                                                         Conductive paste or gel     34      A                                                                                                     C                          D1E P      01985010119960101        N                           
A4561001003PESSARY, RUBBER, ANY TYPE                                                       Pessary rubber, any type    38      A                                                                                                     C                          D1F P      02001010120010101        N                           
A4562001003PESSARY, NON RUBBER, ANY TYPE                                                   Pessary, non rubber,any type38      A                                                                                                     C                          D1F P      02001010120010101        N                           
A4565001003SLINGS                                                                          Slings                      52      A                                                                                                     C                          D1A P      01983010119960101        N                           
A4570001003SPLINT                                                                          Splint                      52      A                  2079                                                                               I                          D1A P      01982010120010701        N                           
A4572001003RIB BELT                                                                        Rib belt                    52      A                                                                            L0210                    C                          D1A P      0198201012003010120021231N                           
A4575001003TOPICAL HYPERBARIC OXYGEN CHAMBER, DISPOSABLE                                   Hyperbaric o2 chamber disps 00      935-10                                                                                                M                          D1A 9      01996010119960101        N                           
A4580001003CAST SUPPLIES (E.G. PLASTER)                                                    Cast supplies (plaster)     00      9                  2079                                                                               I                          D1A 9      01982010120030101        N                           
A4590001003SPECIAL CASTING MATERIAL (E.G. FIBERGLASS)                                      Special casting material    00      9                  2079                                                                               I                          D1A 9      01984010120030101        N                           
A4595001003ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G. TENS, NMES)            TENS suppl 2 lead per month 34      A45-25                                                                                                D                          D1E P      01996010120030101        N                           
A4604001003TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE    Tubing with heating element 32      A                                                                                                     C                          D1E P      02006010120060101        A                           
A4604002004DEVICE                                                                                                                                                                                                                                                                                                               
A4605001003TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, EACH                                  Trach suction cath close sys32      A                                                                                                     C                          D1E P      02005010120050101        N                           
A4606001003OXYGEN PROBE FOR USE WITH OXIMETER DEVICE, REPLACEMENT                          Oxygen probe used w oximeter00      9                                                                                                     C                          D1E 9      02003010120030101        N                           
A4608001003TRANSTRACHEAL OXYGEN CATHETER, EACH                                             Transtracheal oxygen cath   32      A                                                                                                     C                          D1E P      02001010120010101        N                           
A4609001003TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR LESS THAN 72 HOURS OF USE, EACH   Trach suction cath clsed sys32      A                                                                            A4605                    C                          D1E P      0200301012005010120041231N                           
A4610001003TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR 72 OR MORE HOURS OF USE, EACH     Trach sctn cath 72h clsedsys32      A                                                                            A4605                    C                          D1E P      0200301012006010120041231N                           
A4611001003BATTERY, HEAVY DUTY; REPLACEMENT FOR PATIENT OWNED VENTILATOR                   Heavy duty battery          32      A                                                                                                     C                          D1E P      01990010119960101        N                           
A4612001003BATTERY CABLES; REPLACEMENT FOR PATIENT-OWNED VENTILATOR                        Battery cables              32      A                                                                                                     C                          D1E P      01990010119960101        N                           
A4613001003BATTERY CHARGER; REPLACEMENT FOR PATIENT-OWNED VENTILATOR                       Battery charger             32      A                                                                                                     C                          D1E P      01990010119960101        N                           
A4614001003PEAK EXPIRATORY FLOW RATE METER, HAND HELD                                      Hand-held PEFR meter        46      A                                                                                                     C                          Z2  9      01999010119990101        N                           
A4615001003CANNULA, NASAL                                                                  Cannula nasal               33      A60-4              3312                                                                               D                          D1C P      01990010119960101        N                           
A4616001003TUBING (OXYGEN), PER FOOT                                                       Tubing (oxygen) per foot    33      A60-4              3312                                                                               D                          D1C P      01990010119960101        N                           
A4617001003MOUTH PIECE                                                                     Mouth piece                 33      A60-4              3312                                                                               D                          D1C P      01990010119960101        N                           
A4618001003BREATHING CIRCUITS                                                              Breathing circuits          32      A60-4              3312                                                                               D                          D1E APR    01990010119930101        N                           
A4619001003FACE TENT                                                                       Face tent                   33      A60-4              3312                                                                               D                          D1C P      01990010119960101        N                           
A4620001003VARIABLE CONCENTRATION MASK                                                     Variable concentration mask 33      A60-4              3312                                                                               D                          D1C P      01990010119960101        N                           
A4621001003TRACHEOTOMY MASK OR COLLAR                                                      Tracheotomy mask or collar  33      A                  2130                                                                               D                          D1C P      0199001012004010120031231N                           
A4622001003TRACHEOSTOMY OR LARYNGECTOMY TUBE                                               Tracheostomy or larngectomy 37      A65-16             2130                                                                               D                          D1F P      0199001012004010120031231N                           
A4623001003TRACHEOSTOMY, INNER CANNULA                                                     Tracheostomy inner cannula  37      A65-16             2130                                                                               D                          D1F P      01990010120040101        N                           
A4624001003TRACHEAL SUCTION CATHETER, ANY TYPE OTHER THAN CLOSED SYSTEM, EACH              Tracheal suction tube       32      A                                                                                                     C                          D1E P      01990010120030101        N                           
A4625001003TRACHEOSTOMY CARE KIT FOR NEW TRACHEOSTOMY                                      Trach care kit for new trach37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A4626001003TRACHEOSTOMY CLEANING BRUSH, EACH                                               Tracheostomy cleaning brush 37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A4627001003SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR USE WITH METERED DOSE       Spacer bag/reservoir        00      9                  2100                                                                               M                          D1A 9      01991010119970101        N                           
A4627002004INHALER                                                                                                                                                                                                                                                                                                              
A4628001003OROPHARYNGEAL SUCTION CATHETER, EACH                                            Oropharyngeal suction cath  32      A                                                                                                     C                          D1E APR    01996010119960101        N                           
A4629001003TRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACHEOSTOMY                              Tracheostomy care kit       37      A                  2130                                                                               D                          D1F P      01996010120030101        N                           
A4630001003REPLACEMENT BATTERIES,  MEDICALLY NECESSARY, TRANSCUTANEOUS ELECTRICAL          Repl bat t.e.n.s. own by pt 32      A65-8                                                                                                 D                          D1E APR    01991010120060101        C                           
A4630002004STIMULATOR, OWNED BY PATIENT                                                                                                                                                                                                                                                                                         
A4631001003REPLACEMENT, BATTERIES FOR MEDICALLY NECESSARY ELECTRONIC WHEEL CHAIR OWNED BY  Wheelchair battery          32      A60-9                                                                                                 D                          D1E APR    0199101012004010120031231N                           
A4631002004PATIENT                                                                                                                                                                                                                                                                                                              
A4632001003REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP, ANY TYPE, EACH                  Infus pump rplcemnt battery 00      9                                                                                                     I                          D1E APR    02003010120060101        F                           
A4633001003REPLACEMENT BULB/LAMP FOR ULTRAVIOLET LIGHT THERAPY SYSTEM, EACH                Uvl replacement bulb        32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A4634001003REPLACEMENT BULB FOR THERAPEUTIC LIGHT BOX, TABLETOP MODEL                      Replacement bulb th lightbox00      9                                                                                                     C                          D1E 9      02003010120030101        N                           
A4635001003UNDERARM  PAD, CRUTCH, REPLACEMENT, EACH                                        Underarm crutch pad         32      A60-9                                                                                                 D                          D1E APR    01991010119960101        N                           
A4636001003REPLACEMENT, HANDGRIP, CANE, CRUTCH, OR WALKER, EACH                            Handgrip for cane etc       32      A60-9                                                                                                 D                          D1E APR    01991010119960101        N                           
A4637001003REPLACEMENT, TIP, CANE, CRUTCH, WALKER, EACH.                                   Repl tip cane/crutch/walker 32      A60-9                                                                                                 D                          D1E APR    01991010119960101        N                           
A4638001003REPLACEMENT BATTERY FOR PATIENT-OWNED EAR PULSE GENERATOR, EACH                 Repl batt pulse gen sys     32      A                                                                                                     C                          D1E P      02004010120040101        N                           
A4639001003REPLACEMENT PAD FOR INFRARED HEATING PAD SYSTEM, EACH                           Infrared ht sys replcmnt pad32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A4640001003REPLACEMENT PAD  FOR USE WITH MEDICALLY NECESSARY ALTERNATING PRESSURE PAD      Alternating pressure pad    32      A60-9              4107.6                                                                             D                          D1E APR    01991010119960101        N                           
A4640002004OWNED BY PATIENT                                                                                                                                                                                                                                                                                                     
A4641001003RADIOPHARMACEUTICAL, DIAGNOSTIC, NOT OTHERWISE CLASSIFIED                       Radiopharm dx agent noc     51      A                                                                                                     C                          I1E 4      01994010120060101        B                           
A4642001003INDIUM IN-111 SATUMOMAB PENDETIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 6          In111 satumomab             51      A                                                                                                     C                          I1E 4      01995010120060101        B                           
A4642002004MILLICURIES                                                                                                                                                                                                                                                                                                          
A4643001003SUPPLY OF ADDITIONAL HIGH DOSE CONTRAST MATERIAL(S) DURING MAGNETIC RESONANCE   High dose contrast MRI      00      9                                                                                                     I                          I2D 4      0199501012006010120051231D                           
A4643002004IMAGING, E.G., GADOTERIDOL INJECTION                                                                                                                                                                                                                                                                                 
A4644001003SUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (100-199 MGS OF IODINE)                 Contrast 100-199 MGs iodine 00      9                                                                                                     I                          I1E 4      0199401012006010120051231D                           
A4645001003SUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (200-299 MGS OF IODINE)                 Contrast 200-299 MGs iodine 00      9                                                                                                     I                          I1F 4      0199401012006010120051231D                           
A4646001003SUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (300-399 MGS OF IODINE)                 Contrast 300-399 MGs iodine 00      9                                                                                                     I                          I1F 4      0199401012006010120051231D                           
A4647001003SUPPLY OF PARAMAGNETIC CONTRAST MATERIAL, EG., GADOLINIUM                       Supp- paramagnetic contr mat00      9                                                                                                     I                          I1F 4      0199001012006010120051231D                           
A4649001003SURGICAL SUPPLY; MISCELLANEOUS                                                  Surgical supplies           46      A                                                                                                     C                          D1A 9      01982010119980101        N                           
A4651001003CALIBRATED MICROCAPILLARY TUBE, EACH                                            Calibrated microcap tube    52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4652001003MICROCAPILLARY TUBE SEALANT                                                     Microcapillary tube sealant 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4653001003PERITONEAL DIALYSIS CATHETER ANCHORING DEVICE, BELT, EACH                       PD catheter anchor belt     52      A                                                                                                     C                          P9B L      02003010120030101        N                           
A4656001003NEEDLE, ANY SIZE, EACH                                                          Needle any size             52      A                  4270                                                                               D                      0017P9B L      0200201012006010120051231D                           
A4657001003SYRINGE, WITH OR WITHOUT NEEDLE, EACH                                           Syringe w/wo needle         52      A                  4270                                                                               D                      0017P9B L      02002010120030101        N                           
A4660001003SPHYGMOMANOMETER/BLOOD PRESSURE APPARATUS WITH CUFF AND STETHOSCOPE             Sphyg/bp app w cuff and stet52      A                  4270                                                                               D                      0017P9B L      01986010120030101        N                           
A4663001003BLOOD PRESSURE CUFF ONLY                                                        Dialysis blood pressure cuff52      A                  4270                                                                               D                      0017P9B L      01986010120030101        N                           
A4670001003AUTOMATIC BLOOD PRESSURE MONITOR                                                Automatic bp monitor, dial  00      950-42             4270                                                                               M                      0017P9B L      01986010120030101        N                           
A4671001003DISPOSABLE CYCLER SET USED WITH CYCLER DIALYSIS MACHINE, EACH                   Disposable cycler set       52      A                  4270                                                                               D                          P9B L      02004010120040101        N                           
A4672001003DRAINAGE EXTENSION LINE, STERILE, FOR DIALYSIS, EACH                            Drainage ext line, dialysis 52      A                  4270                                                                               D                          P9B L      02004010120040101        N                           
A4673001003EXTENSION LINE WITH EASY LOCK CONNECTORS, USED WITH DIALYSIS                    Ext line w easy lock connect52      A                  4270                                                                               D                          P9B L      02004010120040101        N                           
A4674001003CHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERILIZE DIALYSIS EQUIPMENT, PER  Chem/antisept solution, 8oz 52      A                  4270                                                                               D                          P9B L      02004010120040101        N                           
A46740020048 OZ                                                                                                                                                                                                                                                                                                                 
A4680001003ACTIVATED CARBON FILTER FOR HEMODIALYSIS, EACH                                  Activated carbon filter, ea 52      A55-1              4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4690001003DIALYZER (ARTIFICIAL KIDNEYS), ALL TYPES, ALL SIZES, FOR HEMODIALYSIS, EACH     Dialyzer, each              52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4706001003BICARBONATE CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON                 Bicarbonate conc sol per gal52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4707001003BICARBONATE CONCENTRATE, POWDER, FOR HEMODIALYSIS, PER PACKET                   Bicarbonate conc pow per pac52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4708001003ACETATE CONCENTRATE SOLUTION, FOR HEMODIALYSIS, PER GALLON                      Acetate conc sol per gallon 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4709001003ACID CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON                        Acid conc sol per gallon    52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4712001003WATER, STERILE, FOR INJECTION, PER 10 ML                                        Sterile water inj per 10 ml 52      A                  4270                                                                               D                      0017P9B L      0198601012004010120031231N                           
A4714001003TREATED WATER (DEIONIZED, DISTILLED, OR REVERSE OSMOSIS) FOR PERITONEAL         Treated water per gallon    52      A55-1              4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4714002004DIALYSIS, PER GALLON                                                                                                                                                                                                                                                                                                 
A4719001003"Y SET" TUBING FOR PERITONEAL DIALYSIS                                          "Y set" tubing              52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4720001003DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialysat sol fld vol > 249cc52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4720002004249CC, BUT LESS THAN OR EQUAL TO 999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                      
A4721001003DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialysat sol fld vol > 999cc52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4721002004999CC BUT LESS THAN OR EQUAL TO 1999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                      
A4722001003DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 1999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A47220020041999CC BUT LESS THAN OR EQUAL TO 2999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                     
A4723001003DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 2999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A47230020042999CC BUT LESS THAN OR EQUAL TO 3999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                     
A4724001003DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 3999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A47240020043999CC BUT LESS THAN OR EQUAL TO 4999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                     
A4725001003DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 4999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A47250020044999CC BUT LESS THAN OR EQUAL TO 5999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                     
A4726001003DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN    Dialys sol fld vol > 5999cc 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A47260020045999CC, FOR PERITONEAL DIALYSIS                                                                                                                                                                                                                                                                                      
A4728001003DIALYSATE SOLUTION, NON-DEXTROSE CONTAINING, 500 ML                             Dialysate solution, non-dex 52      A                                                                                                     C                          P9B L      02004010120040101        N                           
A4730001003FISTULA CANNULATION SET FOR HEMODIALYSIS, EACH                                  Fistula cannulation set, ea 52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4736001003TOPICAL ANESTHETIC, FOR DIALYSIS, PER GRAM                                      Topical anesthetic, per gram52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4737001003INJECTABLE ANESTHETIC, FOR DIALYSIS, PER 10 ML                                  Inj anesthetic per 10 ml    52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4740001003SHUNT ACCESSORY, FOR HEMODIALYSIS, ANY TYPE, EACH                               Shunt accessory             52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4750001003BLOOD TUBING, ARTERIAL OR VENOUS, FOR HEMODIALYSIS, EACH                        Art or venous blood tubing  52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4755001003BLOOD TUBING, ARTERIAL AND VENOUS COMBINED, FOR HEMODIALYSIS, EACH              Comb art/venous blood tubing52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4760001003DIALYSATE SOLUTION TEST KIT, FOR PERITONEAL DIALYSIS, ANY TYPE, EACH            Dialysate sol test kit, each52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4765001003DIALYSATE CONCENTRATE, POWDER, ADDITIVE FOR PERITONEAL DIALYSIS, PER PACKET     Dialysate conc pow per pack 52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4766001003DIALYSATE CONCENTRATE, SOLUTION, ADDITIVE FOR PERITONEAL DIALYSIS, PER 10 ML    Dialysate conc sol add 10 ml52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4770001003BLOOD COLLECTION TUBE, VACUUM, FOR DIALYSIS, PER 50                             Blood collection tube/vacuum52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4771001003SERUM CLOTTING TIME TUBE, FOR DIALYSIS, PER 50                                  Serum clotting time tube    52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4772001003BLOOD GLUCOSE TEST STRIPS, FOR DIALYSIS, PER 50                                 Blood glucose test strips   52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4773001003OCCULT BLOOD TEST STRIPS, FOR DIALYSIS, PER 50                                  Occult blood test strips    52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4774001003AMMONIA TEST STRIPS, FOR DIALYSIS, PER 50                                       Ammonia test strips         52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4801001003HEPARIN, ANY TYPE, FOR HEMODIALYSIS, PER 1000 UNITS                             Heparin per 1000 units      52      A                  4270                                                      J1644                    D                      0017P9B L      0200201012003010120021231N                           
A4802001003PROTAMINE SULFATE, FOR HEMODIALYSIS, PER 50 MG                                  Protamine sulfate per 50 mg 52      A                  4270                                                                               D                      0017P9B L      02002010120020101        N                           
A4860001003DISPOSABLE CATHETER TIPS FOR PERITONEAL DIALYSIS, PER 10                        Disposable catheter tips    52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4870001003PLUMBING AND/OR ELECTRICAL WORK FOR HOME HEMODIALYSIS EQUIPMENT                 Plumb/elec wk hm hemo equip 52      A                  4270                                                                               D                      0017P9B L      01986010120020101        N                           
A4890001003CONTRACTS, REPAIR AND MAINTENANCE, FOR HEMODIALYSIS EQUIPMENT                   Repair/maint cont hemo equip52      A                  2100.4                                                                             D                      0017P9B L      01986010120020101        N                           
A4911001003DRAIN BAG/BOTTLE, FOR DIALYSIS, EACH                                            Drain bag/bottle            52      A                                                                                                     D                      0017P9B L      02002010120020101        N                           
A4913001003MISCELLANEOUS DIALYSIS SUPPLIES, NOT OTHERWISE SPECIFIED                        Misc dialysis supplies noc  52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
A4918001003VENOUS PRESSURE CLAMP, FOR HEMODIALYSIS, EACH                                   Venous pressure clamp       52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
A4927001003GLOVES, NON-STERILE, PER 100                                                    Non-sterile gloves          52      A                                                                                                     D                      0017P9B L      01986010120030101        N                           
A4928001003SURGICAL MASK, PER 20                                                           Surgical mask               52      A                                                                                                     D                      0017P9B L      02002010120030101        N                           
A4929001003TOURNIQUET FOR DIALYSIS, EACH                                                   Tourniquet for dialysis, ea 52      A                                                                                                     D                      0017P9B L      02002010120020101        N                           
A4930001003GLOVES, STERILE, PER PAIR                                                       Sterile, gloves per pair    52      A                                                                                                     D                      0017P9B L      02003010120030101        N                           
A4931001003ORAL THERMOMETER, REUSABLE, ANY TYPE, EACH                                      Reusable oral thermometer   52      A                                                                                                     C                          P9B L      02003010120030101        N                           
A4932001003RECTAL THERMOMETER, REUSABLE, ANY TYPE, EACH                                    Reusable rectal thermometer 00      9                                                                                                     I                          Z2  9      02003010120060101        F                           
A5051001003OSTOMY POUCH, CLOSED; WITH BARRIER ATTACHED (1 PIECE), EACH                     Pouch clsd w barr attached  37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5052001003OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED (1 PIECE), EACH                  Clsd ostomy pouch w/o barr  37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5053001003OSTOMY POUCH, CLOSED; FOR USE ON FACEPLATE, EACH                                Clsd ostomy pouch faceplate 37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5054001003OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH            Clsd ostomy pouch w/flange  37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5055001003STOMA CAP                                                                       Stoma cap                   37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5061001003OSTOMY POUCH, DRAINABLE; WITH BARRIER ATTACHED, (1 PIECE), EACH                 Pouch drainable w barrier at37      A                                                                                                     C                          D1F P      01990010120030101        N                           
A5062001003OSTOMY POUCH, DRAINABLE; WITHOUT BARRIER ATTACHED (1 PIECE), EACH               Drnble ostomy pouch w/o barr37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5063001003OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH FLANGE (2 PIECE SYSTEM), EACH  Drain ostomy pouch w/flange 37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5071001003OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED (1 PIECE), EACH                    Urinary pouch w/barrier     37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5072001003OSTOMY POUCH, URINARY; WITHOUT BARRIER ATTACHED (1 PIECE), EACH                 Urinary pouch w/o barrier   37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5073001003OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE (2 PIECE), EACH           Urinary pouch on barr w/flng37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5081001003CONTINENT DEVICE; PLUG FOR CONTINENT STOMA                                      Continent stoma plug        37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5082001003CONTINENT DEVICE; CATHETER FOR CONTINENT STOMA                                  Continent stoma catheter    37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5093001003OSTOMY ACCESSORY; CONVEX INSERT                                                 Ostomy accessory convex inse37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5102001003BEDSIDE DRAINAGE BOTTLE WITH OR WITHOUT TUBING, RIGID OR EXPANDABLE, EACH       Bedside drain btl w/wo tube 37      A                  2130                                                                               D                          D1F P      01990010119970101        N                           
A5105001003URINARY SUSPENSORY; WITH LEG BAG, WITH OR WITHOUT TUBE                          Urinary suspensory          37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5112001003URINARY LEG BAG; LATEX                                                          Urinary leg bag             37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5113001003LEG STRAP; LATEX, REPLACEMENT ONLY, PER SET                                     Latex leg strap             37      A                  2130                                                                               D                          D1F P      01990010119980101        N                           
A5114001003LEG STRAP; FOAM OR FABRIC,  REPLACEMENT ONLY, PER SET                           Foam/fabric leg strap       37      A                  2130                                                                               D                          D1F P      01990010119980101        N                           
A5119001003SKIN BARRIER, WIPES OR SWABS, PER BOX 50                                        Skin barrier wipes box pr 5037      A                  2130                                                                               D                          D1F P      0199001012006010120051231D                           
A5120001003SKIN BARRIER, WIPES OR SWABS, EACH                                              Skin barrier, wipe or swab  37      A                  2130                                                                               D                          D1F P      02006010120060101        A                           
A5121001003SKIN BARRIER; SOLID, 6 X 6 OR EQUIVALENT, EACH                                  Solid skin barrier 6x6      37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5122001003SKIN BARRIER; SOLID, 8 X 8 OR EQUIVALENT, EACH                                  Solid skin barrier 8x8      37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5123001003SKIN BARRIER; WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), ANY SIZE, EACH        Skin barrier with flange    37      A                  2130                                                                               D                          D1A P      0199001012003010120021231N                           
A5126001003ADHESIVE OR NON-ADHESIVE;  DISK OR FOAM PAD                                     Disk/foam pad +or- adhesive 37      A                  2130                                                                               D                          D1F P      01990010120000101        N                           
A5131001003APPLIANCE CLEANER, INCONTINENCE AND OSTOMY APPLIANCES, PER 16 OZ.               Appliance cleaner           37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5200001003PERCUTANEOUS CATHETER/TUBE ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT           Percutaneous catheter anchor37      A                  2130                                                                               D                          D1F P      01999010120030101        N                           
A5500001003FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND       Diab shoe for density insert38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5500002004SUPPLY OF OFF-THE-SHELF DEPTH-INLAY SHOE MANUFACTURED TO ACCOMMODATE MULTI-                                                                                                                                                                                                                                          
A5500003004DENSITY INSERT(S), PER SHOE.                                                                                                                                                                                                                                                                                         
A5501001003FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND       Diabetic custom molded shoe 38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5501002004SUPPLY OF SHOE MOLDED FROM CAST(S) OF PATIENT'S FOOT (CUSTOM MOLDED SHOE), PER                                                                                                                                                                                                                                       
A5501003004SHOE                                                                                                                                                                                                                                                                                                                 
A5503001003FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF           Diabetic shoe w/roller/rockr38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5503002004DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH ROLLER OR RIGID ROCKER BOTTOM, PER                                                                                                                                                                                                                                       
A5503003004SHOE                                                                                                                                                                                                                                                                                                                 
A5504001003FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF           Diabetic shoe with wedge    38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5504002004DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH WEDGE(S), PER SHOE                                                                                                                                                                                                                                                       
A5505001003FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF           Diab shoe w/metatarsal bar  38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5505002004DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH METATARSAL BAR, PER SHOE                                                                                                                                                                                                                                                 
A5506001003FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF           Diabetic shoe w/off set heel38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5506002004DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH OFF-SET HEEL(S), PER SHOE                                                                                                                                                                                                                                                
A5507001003FOR DIABETICS ONLY, NOT OTHERWISE SPECIFIED MODIFICATION (INCLUDING FITTING) OF Modification diabetic shoe  38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5507002004OFF-THE-SHELF DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE, PER SHOE                                                                                                                                                                                                                                                       
A5508001003FOR DIABETICS ONLY, DELUXE FEATURE OF OFF-THE-SHELF DEPTH-INLAY SHOE OR         Diabetic deluxe shoe        38      A                  2134                                                                               D                          D1F J      02000010120050101        N                           
A5508002004CUSTOM-MOLDED SHOE, PER SHOE                                                                                                                                                                                                                                                                                         
A5509001003FOR DIABETICS ONLY, DIRECT FORMED, MOLDED TO FOOT WITH EXTERNAL HEAT SOURCE     Direct heat form shoe insert00      9                  2134                                                                               I                          D1F J      0200201012006010120051231D                           
A5509002004(I.E. HEAT GUN) MULTIPLE DENSITY INSERT (S), PREFABRICATED, PER SHOE                                                                                                                                                                                                                                                 
A5510001003FOR DIABETICS ONLY, DIRECT FORMED, COMPRESSION MOLDED TO PATIENT'S FOOT WITHOUT Compression form shoe insert38      A                  2134                                                                               D                          D1F J      02002010120050101        N                           
A5510002004EXTERNAL HEAT SOURCE, MULTIPLE-DENSITY INSERT(S) PREFABRICATED, PER SHOE                                                                                                                                                                                                                                             
A5511001003FOR DIABETICS ONLY, CUSTOM-MOLDED FROM MODEL OF PATIENT'S FOOT, MULTIPLE        Custom fab molded shoe inser00      9                  2134                                                                               I                          D1F J      0200201012006010120051231D                           
A5511002004DENSITY INSERT(S), CUSTOM-FABRICATED, PER SHOE                                                                                                                                                                                                                                                                       
A5512001003FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT      Multi den insert direct form52      A                                                                                                     C                          D1F J      02006010120060101        A                           
A5512002004AFTER EXTERNAL HEAT SOURCE OF 230 DEGREES FAHRENHEIT OR HIGHER, TOTAL CONTACT                                                                                                                                                                                                                                        
A5512003004WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER MINIMUM OF 1/4 INCH MATERIAL OF                                                                                                                                                                                                                                      
A5512004004SHORE A 35 DUROMETER OR 3/16 INCH MATERIAL OF SHORE A 40 DUROMETER (OR HIGHER),                                                                                                                                                                                                                                      
A5512005004PREFABRICATED, EACH                                                                                                                                                                                                                                                                                                  
A5513001003FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, CUSTOM MOLDED FROM MODEL OF        Multi den insert custom mold52      A                                                                                                     C                          D1F J      02006010120060101        A                           
A5513002004PATIENT'S FOOT, TOTAL CONTACT WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER                                                                                                                                                                                                                                        
A5513003004MINIMUM OF 1/4 INCH MATERIAL OF SHORE A 35 DUROMETER OR 3/16 INCH MATERIAL OF                                                                                                                                                                                                                                        
A5513004004SHORE A 40 DUROMETER (OR HIGHER), INCLUDES ARCH FILLER AND OTHER SHAPING                                                                                                                                                                                                                                             
A5513005004MATERIAL, CUSTOM FABRICATED, EACH                                                                                                                                                                                                                                                                                    
A6000001003NON-CONTACT WOUND WARMING WOUND COVER FOR USE WITH THE NON-CONTACT WOUND        Wound warming wound cover   00      9                  2303                                                                               M                          D1E P      02002010120020701        N                           
A6000002004WARMING DEVICE AND WARMING CARD                                                                                                                                                                                                                                                                                      
A6010001003COLLAGEN BASED WOUND FILLER, DRY FORM, PER GRAM OF COLLAGEN                     Collagen based wound filler 35      A                  2079                                                                               D                          D1A S      02002010120030101        N                           
A6011001003COLLAGEN BASED WOUND FILLER, GEL/PASTE, PER GRAM OF COLLAGEN                    Collagen gel/paste wound fil35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6021001003COLLAGEN DRESSING, PAD SIZE 16 SQ. IN. OR LESS, EACH                            Collagen dressing <=16 sq in35      A                  2079                                                                               D                          D1A S      02001010120030101        N                           
A6022001003COLLAGEN 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      02001010120030101        N                           
A6022002004SQ. IN., EACH                                                                                                                                                                                                                                                                                                        
A6023001003COLLAGEN DRESSING, PAD SIZE MORE THAN 48 SQ. IN., EACH                          Collagen dressing >48 sq in 35      A                  2079                                                                               D                          D1A S      02001010120030101        N                           
A6024001003COLLAGEN DRESSING WOUND FILLER, PER 6 INCHES                                    Collagen dsg wound filler   35      A                  2079                                                                               D                          D1A S      02001010120030101        N                           
A6025001003GEL SHEET FOR DERMAL OR EPIDERMAL APPLICATION, (E.G., SILICONE, HYDROGEL,       Silicone gel sheet, each    00      9                                                                                                     I                          D1A 9      01997010120060101        F                           
A6025002004OTHER), EACH                                                                                                                                                                                                                                                                                                         
A6154001003WOUND POUCH, EACH                                                               Wound pouch each            35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6196001003ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR   Alginate dressing <=16 sq in35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6196002004LESS, EACH DRESSING                                                                                                                                                                                                                                                                                                  
A6197001003ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, PAD SIZE MORE THAN 16    Alginate drsg >16 <=48 sq in35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6197002004SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING                                                                                                                                                                                                                                                          
A6198001003ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, PAD SIZE MORE THAN 48    alginate dressing > 48 sq in46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6198002004SQ. IN., EACH DRESSING                                                                                                                                                                                                                                                                                               
A6199001003ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, PER 6 INCHES            Alginate drsg wound filler  35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6200001003COMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH  Compos drsg <=16 no border  35      A                  2079                                                                               D                          D1A S      01999010120030101        N                           
A6200002004DRESSING                                                                                                                                                                                                                                                                                                             
A6201001003COMPOSITE 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      01999010120030101        N                           
A6201002004SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                      
A6202001003COMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER,     Compos drsg >48 no border   46      A                  2079                                                                               D                          D1A S      01999010120030101        N                           
A6202002004EACH DRESSING                                                                                                                                                                                                                                                                                                        
A6203001003COMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, Composite drsg <= 16 sq in  35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6203002004EACH DRESSING                                                                                                                                                                                                                                                                                                        
A6204001003COMPOSITE 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      01997010120030101        N                           
A6204002004SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                
A6205001003COMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY SIZE ADHESIVE       Composite drsg > 48 sq in   46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6205002004BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A6206001003CONTACT LAYER, 16 SQ. IN. OR LESS, EACH DRESSING                                Contact layer <= 16 sq in   46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6207001003CONTACT 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      01997010120030101        N                           
A6207002004DRESSING                                                                                                                                                                                                                                                                                                             
A6208001003CONTACT LAYER, MORE THAN 48 SQ. IN., EACH DRESSING                              Contact layer > 48 sq in    46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6209001003FOAM 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      01997010120030101        N                           
A6209002004BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A6210001003FOAM 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      01997010120030101        N                           
A6210002004EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                          
A6211001003FOAM 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      01997010120030101        N                           
A6211002004BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A6212001003FOAM 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      01997010120030101        N                           
A6212002004BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A6213001003FOAM 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      01997010120030101        N                           
A6213002004EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                    
A6214001003FOAM 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      01997010120030101        N                           
A6214002004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6215001003FOAM DRESSING, WOUND FILLER, PER GRAM                                           Foam dressing wound filler  46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6216001003GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT       Non-sterile gauze<=16 sq in 35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6216002004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6217001003GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS     Non-sterile gauze>16<=48 sq 35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6217002004THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                  
A6218001003GAUZE, NON-IMPREGNATED, NON-STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT     Non-sterile gauze > 48 sq in46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6218002004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6219001003GAUZE, NON-IMPREGNATED, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE     Gauze <= 16 sq in w/border  35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6219002004BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A6220001003GAUZE, 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      01997010120030101        N                           
A622000200448 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                             
A6221001003GAUZE, 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      01997010120030101        N                           
A6221002004BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A6222001003GAUZE, 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      01997010120030101        N                           
A622200200416 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                           
A6223001003GAUZE, 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      01997010120030101        N                           
A6223002004MORE THAN 16 SQUARE INCHES, BUT LESS THAN OR EQUAL TO 48 SQUARE INCHES, WITHOUT                                                                                                                                                                                                                                      
A6223003004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6224001003GAUZE, 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      01997010120030101        N                           
A6224002004MORE THAN 48 SQUARE INCHES, WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                   
A6228001003GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SIZE 16 SQ. IN. OR LESS,        Gauze <= 16 sq in water/sal 46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6228002004WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                               
A6229001003GAUZE, 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      01997010120030101        N                           
A6229002004LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                             
A6230001003GAUZE, IMPREGNATED, WATER OR NORMAL SALINE, PAD SIZE MORE THAN 48 SQ. IN.,      Gauze > 48 sq in water/salne46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6230002004WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                               
A6231001003GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, PAD SIZE 16 SQ. IN. OR  Hydrogel dsg<=16 sq in      35      A                  2079                                                                               D                          D1A S      02001010120030101        N                           
A6231002004LESS, EACH DRESSING                                                                                                                                                                                                                                                                                                  
A6232001003GAUZE, IMPREGNATED, HYDROGEL, FOR DIRECT WOUND CONTACT, PAD SIZE GREATER THAN   Hydrogel dsg>16<=48 sq in   35      A                  2079                                                                               D                          D1A S      02001010120030101        N                           
A623200200416 SQ. IN., BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING                                                                                                                                                                                                                                                      
A6233001003GAUZE, IMPREGNATED, HYDROGEL FOR DIRECT WOUND CONTACT, PAD SIZE MORE THAN 48    Hydrogel dressing >48 sq in 35      A                  2079                                                                               D                          D1A S      02001010120030101        N                           
A6233002004SQ. IN., EACH DRESSING                                                                                                                                                                                                                                                                                               
A6234001003HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT        Hydrocolld drg <=16 w/o bdr 35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6234002004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6235001003HYDROCOLLOID 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      01997010120030101        N                           
A6235002004OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                       
A6236001003HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT      Hydrocolld drg > 48 in w/o b35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6236002004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6237001003HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE  Hydrocolld drg <=16 in w/bdr35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6237002004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6238001003HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN Hydrocolld drg >16<=48 w/bdr35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6238002004OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                 
A6239001003HYDROCOLLOID DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH ANY     Hydrocolld drg > 48 in w/bdr46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6239002004SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                  
A6240001003HYDROCOLLOID DRESSING, WOUND FILLER, PASTE, PER FLUID OUNCE                     Hydrocolld drg filler paste 35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6241001003HYDROCOLLOID DRESSING, WOUND FILLER, DRY FORM, PER GRAM                         Hydrocolloid drg filler dry 35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6242001003HYDROGEL DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE   Hydrogel drg <=16 in w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6242002004BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A6243001003HYDROGEL 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      01997010120030101        N                           
A6243002004EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                          
A6244001003HYDROGEL 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      01997010120030101        N                           
A6244002004BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A6245001003HYDROGEL 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      01997010120030101        N                           
A6245002004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6246001003HYDROGEL 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      01997010120030101        N                           
A6246002004EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                    
A6247001003HYDROGEL 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      01997010120030101        N                           
A6247002004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6248001003HYDROGEL DRESSING, WOUND FILLER, GEL, PER FLUID OUNCE                           Hydrogel drsg gel filler    35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6250001003SKIN SEALANTS, PROTECTANTS, MOISTURIZERS, OINTMENTS, ANY TYPE, ANY SIZE         Skin seal protect moisturizr00      9                  2079                                                                               D                          D1A LS     01997010120030101        N                           
A6251001003SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS,        Absorpt drg <=16 sq in w/o b35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6251002004WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                               
A6252001003SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT   Absorpt drg >16 <=48 w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6252002004LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                             
A6253001003SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN.,      Absorpt drg > 48 sq in w/o b35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6253002004WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                               
A6254001003SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE 16 SQ. IN. OR LESS, WITH   Absorpt drg <=16 sq in w/bdr35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6254002004ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                              
A6255001003SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 16 SQ. IN. BUT   Absorpt drg >16<=48 in w/bdr35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6255002004LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                       
A6256001003SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, PAD SIZE MORE THAN 48 SQ. IN., WITH Absorpt drg > 48 sq in w/bdr46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6256002004ANY SIZE ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                              
A6257001003TRANSPARENT FILM, 16 SQ. IN. OR LESS, EACH DRESSING                             Transparent film <= 16 sq in35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6258001003TRANSPARENT 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      01997010120030101        N                           
A6258002004EACH DRESSING                                                                                                                                                                                                                                                                                                        
A6259001003TRANSPARENT FILM, MORE THAN 48 SQ. IN., EACH DRESSING                           Transparent film > 48 sq in 35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6260001003WOUND CLEANSERS, ANY TYPE, ANY SIZE                                             Wound cleanser any type/size00      9                  2079                                                                               D                          D1A LS     01997010120030101        N                           
A6261001003WOUND FILLER,  GEL/PASTE, PER FLUID OUNCE, NOT ELSEWHERE CLASSIFIED             Wound filler gel/paste /oz  46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6262001003WOUND FILLER, DRY FORM, PER GRAM,  NOT ELSEWHERE CLASSIFIED                     Wound filler dry form / gram46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6263001003GAUZE, ELASTIC, NON-STERILE, ALL TYPES, PER LINEAR YARD                         Non-sterile elastic gauze/yd35      A                  2079                                                                               D                          D1A S      0199701012003010120021231N                           
A6264001003GAUZE, NON-ELASTIC, NON-STERILE, PER LINEAR YARD                                Non-sterile no elastic gauze35      A                  2079                                                                               D                          D1A S      0199701012003010120021231N                           
A6265001003TAPE, ALL TYPES, PER 18 SQUARE INCHES                                           Tape per 18 sq inches       35      A                                                                                                     C                          D1A S      0199701012003010120021231N                           
A6266001003GAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALINE, OR ZINC PASTE, ANY WIDTH,  Impreg gauze no h20/sal/yard35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6266002004PER LINEAR YARD                                                                                                                                                                                                                                                                                                      
A6402001003GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE  Sterile gauze <= 16 sq in   35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6402002004BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                                
A6403001003GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 16 SQ. IN. LESS THAN OR     Sterile gauze>16 <= 48 sq in35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6403002004EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                          
A6404001003GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT         Sterile gauze > 48 sq in    35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6404002004ADHESIVE BORDER, EACH DRESSING                                                                                                                                                                                                                                                                                       
A6405001003GAUZE, ELASTIC, STERILE, ALL TYPES, PER LINEAR YARD                             Sterile elastic gauze /yd   35      A                  2079                                                                               D                          D1A S      0199701012003010120021231N                           
A6406001003GAUZE, NON-ELASTIC, STERILE, ALL TYPES, PER LINEAR YARD                         Sterile non-elastic gauze/yd35      A                  2079                                                                               D                          D1A S      0199701012003010120021231N                           
A6407001003PACKING STRIPS, NON-IMPREGNATED, UP TO 2 INCHES IN WIDTH, PER LINEAR YARD       Packing strips, non-impreg  35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6410001003EYE PAD, STERILE, EACH                                                          Sterile eye pad             35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6411001003EYE PAD, NON-STERILE, EACH                                                      Non-sterile eye pad         35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6412001003EYE PATCH, OCCLUSIVE, EACH                                                      Occlusive eye patch         00      9                                                                                                     I                          Z2  S      02003010120060101        F                           
A6421001003PADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTED, WIDTH GREATER THAN OR      Pad bandage >=3 <5in w /roll35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A6421002004EQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                                
A6421003004UNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A6422001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN Conf bandage ns >=3<5w/roll35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A6422002004OR EQUAL TO 3 INCHES AND LESS THAN 5 INCHES PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                              
A6422003004UNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A6424001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN Conf bandage ns >=5w /roll 35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A6424002004OR EQUAL TO 5 INCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                                       
A6426001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE WIDTH GREATER THAN OR   Conf bandage s >=3<5 w/roll35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A6426002004EQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                                
A6426003004UNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A6428001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR  Conf bandage s >=5 w /roll 35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A6428002004EQUAL TO 5 INCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                                          
A6430001003LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE LESS THAN    Lt compres bdg >=3<5w /roll35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A64300020041.25 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO 3                                                                                                                                                                                                                                            
A6430003004INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                              
A6432001003LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE LESS THAN    Lt compres bdg >=5w /roll  35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A64320020041.25 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO 5                                                                                                                                                                                                                                            
A6432003004INCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                                                     
A6434001003MODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE OF 1.25   Mo compres bdg >=3<5w /roll35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A6434002004TO 1.34 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO 3                                                                                                                                                                                                                                         
A6434003004INCHES OR LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS, UNSTRETCHED)                                                                                                                                                                                                                                               
A6436001003HIGH COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE GREATER THAN  Hi compres bdg >=3<5w /roll35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A6436002004OR EQUAL TO 1.35 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR                                                                                                                                                                                                                                           
A6436003004EQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                                
A6436004004UNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A6438001003SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, LOAD RESISTANCE GREATER  Self-adher bdg >=3<5w /roll35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A6438002004THAN OR EQUAL TO 0.55 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR                                                                                                                                                                                                                                      
A6438003004EQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 3 YARDS,                                                                                                                                                                                                                                                
A6438004004UNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A6440001003ZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN  Zinc paste bdg >=3<5w /roll35      A                                                                                                     C                          D1A S      0200301012004010120031231N                           
A6440002004OR EQUAL TO 3 INCHES AND LESS THAN 5 INCHES, PER ROLL (AT LEAST 10 YARDS,                                                                                                                                                                                                                                            
A6440003004UNSTRETCHED)                                                                                                                                                                                                                                                                                                         
A6441001003PADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTED, WIDTH GREATER THAN OR      Pad band w>=3 <5/yd       35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6441002004EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                            
A6442001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH LESS THAN    Conform band n/s w<3/yd    35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6442002004THREE INCHES, PER YARD                                                                                                                                                                                                                                                                                               
A6443001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN Conform band n/s w>=3<5/yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6443002004OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                         
A6444001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN Conform band n/s w>=5/yd   35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6444002004OR EQUAL TO 5 INCHES, PER YARD                                                                                                                                                                                                                                                                                       
A6445001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH LESS THAN THREE  Conform band s w <3/yd     35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6445002004INCHES, PER YARD                                                                                                                                                                                                                                                                                                     
A6446001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR  Conform band s w>=3 <5/yd 35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6446002004EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                            
A6447001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR  Conform band s w >=5/yd    35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6447002004EQUAL TO FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                                       
A6448001003LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH LESS THAN THREE        Lt compres band <3/yd      35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6448002004INCHES, PER YARD                                                                                                                                                                                                                                                                                                     
A6449001003LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL  Lt compres band >=3 <5/yd 35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6449002004TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                  
A6450001003LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL  Lt compres band >=5/yd     35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6450002004TO FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                                             
A6451001003MODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE OF 1.25   Mod compres band w>=3<5/yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6451002004TO 1.34 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR EQUAL TO                                                                                                                                                                                                                                           
A6451003004THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                     
A6452001003HIGH COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE GREATER THAN  High compres band w>=3<5yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6452002004OR EQUAL TO 1.35 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR                                                                                                                                                                                                                                           
A6452003004EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                            
A6453001003SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH LESS THAN THREE    Self-adher band w <3/yd    35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6453002004INCHES, PER YARD                                                                                                                                                                                                                                                                                                     
A6454001003SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR    Self-adher band w>=3 <5/yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6454002004EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                            
A6455001003SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR    Self-adher band >=5/yd     35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6455002004EQUAL TO FIVE INCHES, PER YARD                                                                                                                                                                                                                                                                                       
A6456001003ZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN  Zinc paste band w >=3<5/yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6456002004OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD                                                                                                                                                                                                                                                         
A6457001003TUBULAR DRESSING WITH OR WITHOUT ELASTIC, ANY WIDTH, PER LINEAR YARD            Tubular dressing            35      A                                                                                                     C                          D1A S      02006010120060101        A                           
A6501001003COMPRESSION BURN GARMENT, BODYSUIT (HEAD TO FOOT), CUSTOM FABRICATED            Compres burngarment bodysuit35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6502001003COMPRESSION BURN GARMENT, CHIN STRAP, CUSTOM FABRICATED                         Compres burngarment chinstrp35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6503001003COMPRESSION BURN GARMENT, FACIAL HOOD, CUSTOM FABRICATED                        Compres burngarment facehood35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6504001003COMPRESSION BURN GARMENT, GLOVE TO WRIST, CUSTOM FABRICATED                     Cmprsburngarment glove-wrist35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6505001003COMPRESSION BURN GARMENT, GLOVE TO ELBOW, CUSTOM FABRICATED                     Cmprsburngarment glove-elbow35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6506001003COMPRESSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM FABRICATED                    Cmprsburngrmnt glove-axilla 35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6507001003COMPRESSION BURN GARMENT, FOOT TO KNEE LENGTH, CUSTOM FABRICATED                Cmprs burngarment foot-knee 35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6508001003COMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CUSTOM FABRICATED               Cmprs burngarment foot-thigh35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6509001003COMPRESSION BURN GARMENT, UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS (VEST),   Compres burn garment jacket 35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6509002004CUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
A6510001003COMPRESSION BURN GARMENT, TRUNK, INCLUDING ARMS DOWN TO LEG OPENINGS (LEOTARD), Compres burn garment leotard35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6510002004CUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
A6511001003COMPRESSION BURN GARMENT, LOWER TRUNK INCLUDING LEG OPENINGS (PANTY), CUSTOM    Compres burn garment panty  35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6511002004FABRICATED                                                                                                                                                                                                                                                                                                           
A6512001003COMPRESSION BURN GARMENT, NOT OTHERWISE CLASSIFIED                              Compres burn garment, noc   35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6513001003COMPRESSION BURN MASK, FACE AND/OR NECK, PLASTIC OR EQUAL, CUSTOM FABRICATED    Compress burn mask face/neck00      9                                                                                                     C                          D1A P      02006010120060101        A                           
A6530001003GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH                     Compression stocking BK18-3000      960-9                                                                                                 M                      0072D1F P      02006010120060101        A                           
A6531001003GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH                     Compression stocking BK30-4035      A                  2079                                                                               D                      0072D1A PS     02006010120060101        A                           
A6532001003GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH                     Compression stocking BK40-5035      A                  2079                                                                               D                      0072D1A PS     02006010120060101        A                           
A6533001003GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH                   Gc stocking thighlngth 18-3000      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6534001003GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH                   Gc stocking thighlngth 30-4000      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6535001003GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH                   Gc stocking thighlngth 40-5000      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6536001003GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH         Gc stocking full lngth 18-3000      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6537001003GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH         Gc stocking full lngth 30-4000      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6538001003GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH         Gc stocking full lngth 40-5000      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6539001003GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH                   Gc stocking waistlngth 18-3000      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6540001003GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH                   Gc stocking waistlngth 30-4000      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6541001003GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH                   Gc stocking waistlngth 40-5000      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6542001003GRADIENT COMPRESSION STOCKING, CUSTOM MADE                                      Gc stocking custom made     00      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6543001003GRADIENT COMPRESSION STOCKING, LYMPHEDEMA                                       Gc stocking lymphedema      00      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6544001003GRADIENT COMPRESSION STOCKING, GARTER BELT                                      Gc stocking garter belt     00      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6549001003GRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED                          G compression stocking      00      960-9              2133                                                                               M                      0072D1F P      02006010120060101        A                           
A6550001003WOUND CARE SET, FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, INCLUDES   Neg pres wound ther drsg set34      A                                                                                                     C                          D1E P      02004010120060101        C                           
A6550002004ALL SUPPLIES AND ACCESSORIES                                                                                                                                                                                                                                                                                         
A6551001003CANISTER SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR Neg press wound ther canistr34      A                                                                                                     C                          D1E P      0200401012006010120051231D                           
A6551002004PORTABLE, EACH                                                                                                                                                                                                                                                                                                       
A7000001003CANISTER, DISPOSABLE, USED WITH SUCTION PUMP, EACH                              Disposable canister for pump32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7001001003CANISTER, NON-DISPOSABLE, USED WITH SUCTION PUMP, EACH                          Nondisposable pump canister 32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7002001003TUBING, USED WITH SUCTION PUMP, EACH                                            Tubing used w suction pump  32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7003001003ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER,          Nebulizer administration set32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7003002004DISPOSABLE                                                                                                                                                                                                                                                                                                           
A7004001003SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, DISPOSABLE                        Disposable nebulizer sml vol32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7005001003ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER,          Nondisposable nebulizer set 32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7005002004NON-DISPOSABLE                                                                                                                                                                                                                                                                                                       
A7006001003ADMINISTRATION SET, WITH SMALL VOLUME FILTERED PNEUMATIC NEBULIZER              Filtered nebulizer admin set32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7007001003LARGE VOLUME NEBULIZER, DISPOSABLE, UNFILLED, USED WITH AEROSOL COMPRESSOR      Lg vol nebulizer disposable 32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7008001003LARGE VOLUME NEBULIZER, DISPOSABLE, PREFILLED, USED WITH AEROSOL COMPRESSOR     Disposable nebulizer prefill32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7009001003RESERVOIR BOTTLE, NON-DISPOSABLE, USED WITH LARGE VOLUME ULTRASONIC NEBULIZER   Nebulizer reservoir bottle  32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7010001003CORRUGATED TUBING, DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 100 FEET       Disposable corrugated tubing32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7011001003CORRUGATED TUBING, NON-DISPOSABLE, USED WITH LARGE VOLUME NEBULIZER, 10 FEET    Nondispos corrugated tubing 46      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7012001003WATER COLLECTION DEVICE, USED WITH LARGE VOLUME NEBULIZER                       Nebulizer water collec devic32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7013001003FILTER, DISPOSABLE, USED WITH AEROSOL COMPRESSOR                                Disposable compressor filter32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7014001003FILTER, NONDISPOSABLE, USED WITH AEROSOL COMPRESSOR OR ULTRASONIC GENERATOR     Compressor nondispos filter 32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7015001003AEROSOL MASK, USED WITH DME NEBULIZER                                           Aerosol mask used w nebulize32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7016001003DOME AND MOUTHPIECE, USED WITH SMALL VOLUME ULTRASONIC NEBULIZER                Nebulizer dome & mouthpiece 32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7017001003NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, NOT USED WITH   Nebulizer not used w oxygen 32      A60-9                                                                                                 D                          D1E APR    02000010120000101        N                           
A7017002004OXYGEN                                                                                                                                                                                                                                                                                                               
A7018001003WATER, DISTILLED, USED WITH LARGE VOLUME NEBULIZER, 1000 ML                     Water distilled w/nebulizer 32      A                                                                                                     C                          D1E P      02001010120010101        N                           
A7019001003SALINE SOLUTION, PER 10 ML, METERED DOSE DISPENSER, FOR USE WITH INHALATION     Saline solution dispenser   34      A                                                                                                     C                          D1E P      0200101012004010120031231N                           
A7019002004DRUGS                                                                                                                                                                                                                                                                                                                
A7020001003STERILE WATER OR STERILE SALINE, 1000 ML, USED WITH LARGE VOLUME NEBULIZER      Sterile H2O or NSS w lgv neb34      A                                                                                                     C                          D1E P      0200101012004010120031231N                           
A7025001003HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM VEST, REPLACEMENT FOR USE WITH     Replace chest compress vest 32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7025002004PATIENT OWNED EQUIPMENT, EACH                                                                                                                                                                                                                                                                                        
A7026001003HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM HOSE, REPLACEMENT FOR USE WITH     Replace chst cmprss sys hose32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7026002004PATIENT OWNED EQUIPMENT, EACH                                                                                                                                                                                                                                                                                        
A7030001003FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH                  CPAP full face mask         32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7031001003FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH                       Replacement facemask interfa32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7032001003CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH                 Replacement nasal cushion   32      A                                                                                                     C                          D1E APR    02003010120060101        C                           
A7033001003PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR          Replacement nasal pillows   32      A                                                                                                     C                          D1E APR    02003010120060101        C                           
A7034001003NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE       Nasal application device    32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7034002004DEVICE, WITH OR WITHOUT HEAD STRAP                                                                                                                                                                                                                                                                                   
A7035001003HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE                              Pos airway press headgear   32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7036001003CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE                             Pos airway press chinstrap  32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7037001003TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE                                Pos airway pressure tubing  32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7038001003FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE                   Pos airway pressure filter  32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7039001003FILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE               Filter, non disposable w pap32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7040001003ONE WAY CHEST DRAIN VALVE                                                       One way chest drain valve   38      A                                                                                                     C                          D1F P      02005010120050101        N                           
A7041001003WATER SEAL DRAINAGE CONTAINER AND TUBING FOR USE WITH IMPLANTED CHEST TUBE      Water seal drain container  38      A                                                                                                     C                          D1F P      02005010120050101        N                           
A7042001003IMPLANTED PLEURAL CATHETER, EACH                                                Implanted pleural catheter  38      A                                                                                                     C                          D1F P      02003010120030101        N                           
A7043001003VACUUM DRAINAGE BOTTLE AND TUBING FOR USE WITH IMPLANTED CATHETER               Vacuum drainagebottle/tubing38      A                                                                                                     C                          D1F P      02003010120030101        N                           
A7044001003ORAL INTERFACE USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH                  PAP oral interface          32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7045001003EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH ACCESSORIES FOR POSITIVE       Repl exhalation port for PAP32      A60-17                                                                                                D                          D1E APR    02005010120050101        N                           
A7045002004AIRWAY DEVICES, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                     
A7046001003WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE,        Repl water chamber, PAP dev 32      A60-17                                                                                                D                          D1E P      02004010120040101        N                           
A7046002004REPLACEMENT, EACH                                                                                                                                                                                                                                                                                                    
A7501001003TRACHEOSTOMA VALVE, INCLUDING DIAPHRAGM, EACH                                   Tracheostoma valve w diaphra37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7502001003REPLACEMENT DIAPHRAGM/FACEPLATE FOR TRACHEOSTOMA VALVE, EACH                    Replacement diaphragm/fplate37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7503001003FILTER HOLDER OR FILTER CAP, REUSABLE, FOR USE IN A TRACHEOSTOMA HEAT AND       HMES filter holder or cap   37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7503002004MOISTURE EXCHANGE SYSTEM, EACH                                                                                                                                                                                                                                                                                       
A7504001003FILTER FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM, EACH        Tracheostoma HMES filter    37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7505001003HOUSING, REUSABLE WITHOUT ADHESIVE, FOR USE IN A HEAT AND MOISTURE EXCHANGE     HMES or trach valve housing 37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7505002004SYSTEM AND/OR WITH A TRACHEOSTOMA VALVE, EACH                                                                                                                                                                                                                                                                        
A7506001003ADHESIVE DISC FOR USE IN A HEAT AND MOISTURE EXCHANGE SYSTEM AND/OR WITH        HMES/trachvalve adhesivedisk37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7506002004TRACHEOSTOMA VALVE, ANY TYPE EACH                                                                                                                                                                                                                                                                                    
A7507001003FILTER HOLDER AND INTEGRATED FILTER WITHOUT ADHESIVE, FOR USE IN A TRACHEOSTOMA Integrated filter & holder  37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7507002004HEAT AND MOISTURE EXCHANGE SYSTEM, EACH                                                                                                                                                                                                                                                                              
A7508001003HOUSING AND INTEGRATED ADHESIVE, FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE    Housing & Integrated Adhesiv37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7508002004EXCHANGE SYSTEM AND/OR WITH A TRACHEOSTOMA VALVE, EACH                                                                                                                                                                                                                                                               
A7509001003FILTER HOLDER AND INTEGRATED FILTER HOUSING, AND ADHESIVE, FOR USE AS A         Heat & moisture exchange sys37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7509002004TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM, EACH                                                                                                                                                                                                                                                                 
A7520001003TRACHEOSTOMY/LARYNGECTOMY TUBE, NON-CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE   Trach/laryn tube non-cuffed 37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7520002004OR EQUAL, EACH                                                                                                                                                                                                                                                                                                       
A7521001003TRACHEOSTOMY/LARYNGECTOMY TUBE, CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE OR    Trach/laryn tube cuffed     37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7521002004EQUAL, EACH                                                                                                                                                                                                                                                                                                          
A7522001003TRACHEOSTOMY/LARYNGECTOMY TUBE, STAINLESS STEEL OR EQUAL (STERILIZABLE AND      Trach/laryn tube stainless  37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7522002004REUSABLE), EACH                                                                                                                                                                                                                                                                                                      
A7523001003TRACHEOSTOMY SHOWER PROTECTOR, EACH                                             Tracheostomy shower protect 37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7524001003TRACHEOSTOMA STENT/STUD/BUTTON, EACH                                            Tracheostoma stent/stud/bttn37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7525001003TRACHEOSTOMY MASK, EACH                                                         Tracheostomy mask           37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7526001003TRACHEOSTOMY TUBE COLLAR/HOLDER, EACH                                           Tracheostomy tube collar    37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7527001003TRACHEOSTOMY/LARYNGECTOMY TUBE PLUG/STOP, EACH                                  Trach/laryn tube plug/stop  37      A                                                                                                     C                          D1A P      02005010120050101        N                           
A9150001003NON-PRESCRIPTION DRUGS                                                          Misc/exper non-prescript dru57      A                  2050.5                                                                             D                          O1E 9      01986010119950401        N                           
A9152001003SINGLE VITAMIN/MINERAL/TRACE ELEMENT, ORAL, PER DOSE, NOT OTHERWISE SPECIFIED   Single vitamin nos          00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
A9153001003MULTIPLE VITAMINS, WITH OR WITHOUT MINERALS AND TRACE ELEMENTS, ORAL, PER DOSE, Multi-vitamin nos           00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
A9153002004NOT OTHERWISE SPECIFIED                                                                                                                                                                                                                                                                                              
A9180001003PEDICULOSIS (LICE INFESTATION) TREATMENT, TOPICAL, FOR ADMINISTRATION BY        Lice treatment, topical     00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
A9180002004PATIENT/CARETAKER                                                                                                                                                                                                                                                                                                    
A9270001003NON-COVERED ITEM OR SERVICE                                                     Non-covered item or service 00      9                  2303                                                                               M                      0106Z2  9      01986010120020101        N                           
A9275001003HOME GLUCOSE DISPOSABLE MONITOR, INCLUDES TEST STRIPS                           Disp home glucose monitor   00      9                                                                                                     M                      0131T1E 9      02006010120060101        A                           
A9280001003ALERT OR ALARM DEVICE, NOT OTHERWISE CLASSIFIED                                 Alert device, noc           00      9                                          1861                                                       S                          Z2  9      02004010120040101        N                           
A9281001003REACHING/GRABBING DEVICE, ANY TYPE, ANY LENGTH, EACH                            Reaching/grabbing device    00      9                                          1862 SSA                                                   S                          D1E APR    02006010120060101        A                           
A9282001003WIG, ANY TYPE, EACH                                                             Wig any type                00      9                                          1861SSA                                                    S                          Z2  9      02006010120060101        A                           
A9300001003EXERCISE EQUIPMENT                                                              Exercise equipment          00      960-9              2100.1                                                                             M                          Z2  9      01993010119950401        N                           
A9500001003TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES   Tc99m sestamibi             57      A                                                                                                     C                          I1E 4      01996010120060101        B                           
A9502001003TECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES Tc99m tetrofosmin           57      A                                                                                                     C                          I1E 4      01998010120060101        B                           
A9503001003TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES   Tc99m medronate             57      A                                                                                                     C                          I1E 4      01997010120060101        B                           
A9504001003TECHNETIUM TC-99M APCITIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES    Tc99m apcitide              57      A                                                                                                     C                          I1E 4      02000010120060101        B                           
A9505001003THALLIUM TL-201 THALLOUS CHLORIDE, DIAGNOSTIC, PER MILLICURIE                   TL201 thallium              57      A                                                                                                     C                          I1E 4      01996010120060101        B                           
A9507001003INDIUM IN-111 CAPROMAB PENDETIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10          In111 capromab              57      A                                                                                                     C                          I1E 4      01999010120060101        B                           
A9507002004MILLICURIES                                                                                                                                                                                                                                                                                                          
A9508001003IODINE I-131 IOBENGUANE SULFATE, DIAGNOSTIC, PER 0.5 MILLICURIE                 I131 iodobenguate, dx       51      A                                                                                                     C                          I1E 4      02001010120060101        B                           
A9510001003TECHNETIUM TC-99M DISOFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES   Tc99m disofenin             51      A                                                                                                     C                          I1E 4      02001010120060101        B                           
A9511001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M,      Technetium TC 99m depreotide57      A                                                                                                     C                          I1E 4      0200201012006010120051231D                           
A9511002004DEPREOTIDE, PER MCI                                                                                                                                                                                                                                                                                                  
A9512001003TECHNETIUM TC-99M PERTECHNETATE, DIAGNOSTIC, PER MILLICURIE                     Tc99m pertechnetate         57      A                                                                                                     C                          I1E 4      02003010120060101        C                           
A9513001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetium tc-99m mebrofenin57      A                                                                                                     C                          I1E 4      0200301012006010120051231D                           
A9513002004MEBROFENIN, PER MCI                                                                                                                                                                                                                                                                                                  
A9514001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetiumtc99mpyrophosphate57      A                                                                                                     C                          I1E 4      0200301012006010120051231D                           
A9514002004PYROPHOSPHATE, PER MCI                                                                                                                                                                                                                                                                                               
A9515001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetium tc-99m pentetate 57      A                                                                                                     C                          I1E 4      0200301012006010120051231D                           
A9515002004PENTETATE, PER MCI                                                                                                                                                                                                                                                                                                   
A9516001003IODINE I-123 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC, PER 100 MICROCURIES          I123 iodide cap, dx         57      A                                                                                                     C                          I1E 4      02003010120060101        C                           
A9517001003IODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER MILLICURIE              I131 iodide cap, rx         57      A                                                                                                     C                          I1E 6      02003010120060101        C                           
A9518001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 SODIUM IODIDE    I-131 sodium iodide solution57      A                                                                            A9530                    C                          I1E 4      0200301012004010120031231N                           
A9518002004SOLUTION, PER UCI                                                                                                                                                                                                                                                                                                    
A9519001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetiumtc-99mmacroag albu57      A                                                                                                     C                          I1E 4      0200301012006010120051231D                           
A9519002004MACROAGGREGATED ALBUMIN, PER MCI                                                                                                                                                                                                                                                                                     
A9520001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetiumtc-99m sulfur clld57      A                                                                                                     C                          I1E 4      0200301012006010120051231D                           
A9520002004SULFUR COLLOID, PER MCI                                                                                                                                                                                                                                                                                              
A9521001003TECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES Tc99m exametazime           57      A                                                                                                     C                          I1E 4      02003010120060101        C                           
A9522001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB  Indium111ibritumomabtiuxetan51      A                  15022                                                                              D                          I1E 4      0200301012006010120051231D                           
A9522002004TIUXETAN, PER MCI                                                                                                                                                                                                                                                                                                    
A9523001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, YTTRIUM 90 IBRITUMOMAB Yttrium90ibritumomabtiuxetan51      A                  15022                                                                              D                          I1E 6      0200301012006010120051231D                           
A9523002004TIUXETAN, PER MCI                                                                                                                                                                                                                                                                                                    
A9524001003IODINE I-131 IODINATED SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES             I131 serum albumin, dx      57      A                                                                                                     C                          I1E 4      02003010120060101        B                           
A9525001003SUPPLY OF LOW OR ISO-OSMOLAR CONTRAST MATERIAL, 10 MG OF IODINE                 Low/iso-osmolar contrast mat00      9                                                                                                     I                          I1F 4      0200401012006010120051231D                           
A9526001003NITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES         Nitrogen N-13 ammonia       53      A                                                                                                     C                          I1E 4      02004010120060101        B                           
A9528001003IODINE I-131 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC, PER MILLICURIE               Iodine I-131 iodide cap, dx 57      A                                                                                                     C                          I1E 4      02004010120060101        C                           
A9529001003IODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC, PER MILLICURIE                 I131 iodide sol, dx         57      A                                                                                                     C                          I1E 4      02004010120060101        C                           
A9530001003IODINE I-131 SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE                I131 iodide sol, rx         57      A                                                                                                     C                          I1E 6      02004010120060101        C                           
A9531001003IODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER MICROCURIE (UP TO 100 MICROCURIES)  I131 max 100uCi             57      A                                                                                                     C                          I1E 4      02004010120060101        C                           
A9532001003IODINE I-125 SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES                       I125 serum albumin, dx      57      A                                                                                                     C                          I1E 6      02004010120060101        C                           
A9533001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER  I-131 tositumomab diagnostic57      A                                                                                                     C                          I1E 4      0200401012006010120051231D                           
A9533002004MILLICURIE                                                                                                                                                                                                                                                                                                           
A9534001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER I-131 tositumomab therapeut 57      A                                                                                                     C                          I1E 6      0200401012006010120051231D                           
A9534002004MILLICURIE                                                                                                                                                                                                                                                                                                           
A9535001003INJECTION, METHYLENE BLUE, 1 ML                                                 Injection, methylene blue   51      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9536001003TECHNETIUM TC-99M DEPREOTIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 35 MILLICURIES  Tc99m depreotide            57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9537001003TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES  Tc99m mebrofenin            57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9538001003TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25           Tc99m pyrophosphate         57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9538002004MILLICURIES                                                                                                                                                                                                                                                                                                          
A9539001003TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES   Tc99m pentetate             57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9540001003TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 Tc99m MAA                   57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9540002004MILLICURIES                                                                                                                                                                                                                                                                                                          
A9541001003TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20          Tc99m sulfur colloid        57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9541002004MILLICURIES                                                                                                                                                                                                                                                                                                          
A9542001003INDIUM IN-111 IBRITUMOMAB TIUXETAN, DIAGNOSTIC, PER STUDY DOSE, UP TO 5         In111 ibritumomab, dx       51      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9542002004MILLICURIES                                                                                                                                                                                                                                                                                                          
A9543001003YTTRIUM Y-90 IBRITUMOMAB TIUXETAN, THERAPEUTIC, PER TREATMENT DOSE, UP TO 40    Y90 ibritumomab, rx         51      A                                                                                                     C                          I1E 6      02006010120060101        A                           
A9543002004MILLICURIES                                                                                                                                                                                                                                                                                                          
A9544001003IODINE I-131 TOSITUMOMAB, DIAGNOSTIC, PER STUDY DOSE                            I131 tositumomab, dx        57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9545001003IODINE I-131 TOSITUMOMAB, THERAPEUTIC, PER TREATMENT DOSE                       I131 tositumomab, rx        57      A                                                                                                     C                          I1E 6      02006010120060101        A                           
A9546001003COBALT CO-57/58, CYANOCOBALAMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURIE Co57/58                     53      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9547001003INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 MILLICURIE                      In111 oxyquinoline          53      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9548001003INDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5 MILLICURIE                         In111 pentetate             53      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9549001003TECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES Tc99m arcitumomab           53      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9550001003TECHNETIUM TC-99M SODIUM GLUCEPTATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25       Tc99m gluceptate            53      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9550002004MILLICURIE                                                                                                                                                                                                                                                                                                           
A9551001003TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES    Tc99m succimer              53      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9552001003FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES   F18 fdg                     53      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9553001003CHROMIUM CR-51 SODIUM CHROMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 250           Cr51 chromate               53      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9553002004MICROCURIES                                                                                                                                                                                                                                                                                                          
A9554001003IODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10           I125 iothalamate, dx        53      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9554002004MICROCURIES                                                                                                                                                                                                                                                                                                          
A9555001003RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP TO 60 MILLICURIES                Rb82 rubidium               99      9                                                                                                     C                          I1E 4      02006010120060101        A                           
A9556001003GALLIUM GA-67 CITRATE, DIAGNOSTIC, PER MILLICURIE                               Ga67 gallium                57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9557001003TECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES    Tc99m bicisate              57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9558001003XENON XE-133 GAS, DIAGNOSTIC, PER 10 MILLICURIES                                Xe133 xenon 10mci           57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9559001003COBALT CO-57 CYANOCOBALAMIN, ORAL, DIAGNOSTIC, PER STUDY DOSE, UP TO 1          Co57 cyano                  57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9559002004MICROCURIE                                                                                                                                                                                                                                                                                                           
A9560001003TECHNETIUM TC-99M LABELED RED BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 Tc99m labeled rbc           57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9560002004MILLICURIES                                                                                                                                                                                                                                                                                                          
A9561001003TECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES  Tc99m oxidronate            57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9562001003TECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES  Tc99m mertiatide            57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9563001003SODIUM PHOSPHATE P-32, THERAPEUTIC, PER MILLICURIE                              P32 Na phosphate            57      A                                                                                                     C                          I1E 6      02006010120060101        A                           
A9564001003CHROMIC PHOSPHATE P-32 SUSPENSION, THERAPEUTIC, PER MILLICURIE                  P32 chromic phosphate       57      A                                                                                                     C                          I1E 6      02006010120060101        A                           
A9565001003INDIUM IN-111 PENTETREOTIDE, DIAGNOSTIC, PER MILLICURIE                         In111 pentetreotide         57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9566001003TECHNETIUM TC-99M FANOLESOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES Tc99m fanolesomab           57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9567001003TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, AEROSOL, PER STUDY DOSE, UP TO 75      Technetium TC-99m aerosol   57      A                                                                                                     C                          I1E 4      02006010120060101        A                           
A9567002004MILLICURIES                                                                                                                                                                                                                                                                                                          
A9600001003STRONTIUM SR-89 CHLORIDE, THERAPEUTIC, PER MILLICURIE                           Sr89 strontium              57      A                                                                                                     C                          I1E 6      01998010120060101        C                           
A9605001003SAMARIUM SM-153 LEXIDRONAMM, THERAPEUTIC, PER 50 MILLICURIES                    Sm 153 lexidronm            57      A                                                                                                     C                          I1E 6      01999010120060101        C                           
A9698001003NON-RADIOACTIVE CONTRAST IMAGING MATERIAL, NOT OTHERWISE CLASSIFIED, PER STUDY  Non-rad contrast materialNOC51      A                  15022                                                                              D                          I1E 4      02006010120060101        A                           
A9699001003RADIOPHARMACEUTICAL, THERAPEUTIC, NOT OTHERWISE CLASSIFIED                      Radiopharm rx agent noc     57      A                                                                                                     C                          I1E 6      02003010120060101        C                           
A9700001003SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY   Echocardiography Contrast   57      A                  15360                                                                              D                          I1E 9      02001010120010101        N                           
A9900001003MISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS  Supply/accessory/service    46      A                                                                                                     C                          D1E 9      02000010120010101        N                           
A9900002004CODE                                                                                                                                                                                                                                                                                                                 
A9901001003DME DELIVERY, SET UP, AND/OR DISPENSING SERVICE COMPONENT OF ANOTHER HCPCS CODE Delivery/set up/dispensing  46      A                                                                                                     C                          D1E 9      02000010120010101        N                           
A9999001003MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED                  DME supply or accessory, nos46      A                                                                                                     C                          D1F 9      02004010120040101        N                           
B4034001003ENTERAL FEEDING SUPPLY KIT; SYRINGE, PER DAY                                    Enter feed supkit syr by day39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4035001003ENTERAL FEEDING SUPPLY KIT;  PUMP FED, PER DAY                                  Enteral feed supp pump per d39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4036001003ENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY                                Enteral feed sup kit grav by39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4081001003NASOGASTRIC TUBING WITH STYLET                                                  Enteral ng tubing w/ stylet 39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4082001003NASOGASTRIC TUBING WITHOUT STYLET                                               Enteral ng tubing w/o stylet39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4083001003STOMACH TUBE - LEVINE TYPE                                                      Enteral stomach tube levine 39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4086001003GASTROSTOMY / JEJUNOSTOMY TUBE, ANY MATERIAL, ANY TYPE, (STANDARD OR LOW        Gastrostomy/jejunostomy tube39      A                                                                                                     C                          O1C E      02002010120020101        N                           
B4086002004PROFILE), EACH                                                                                                                                                                                                                                                                                                       
B4100001003FOOD THICKENER, ADMINISTERED ORALLY, PER OUNCE                                  Food thickener oral         00      960-9                                                                                                 M                          Z2  E      02003010120050101        F                           
B4102001003ENTERAL FORMULA, FOR ADULTS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G.      EF adult fluids and electro 39      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4102002004CLEAR LIQUIDS), 500 ML = 1 UNIT                                                                                                                                                                                                                                                                                      
B4103001003ENTERAL FORMULA, FOR PEDIATRICS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G.  EF ped fluid and electrolyte46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4103002004CLEAR LIQUIDS), 500 ML = 1 UNIT                                                                                                                                                                                                                                                                                      
B4104001003ADDITIVE FOR ENTERAL FORMULA (E.G. FIBER)                                       Additive for enteral formula00      965-10                                                                                                D                          O1C E      02005010120050101        N                           
B4149001003ENTERAL FORMULA, MANUFACTURED BLENDERIZED NATURAL FOODS WITH INTACT NUTRIENTS,  EF blenderized foods        39      A65-10             2130    4450                                                                       D                          O1C E      02005010120060101        C                           
B4149002004INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE                                                                                                                                                                                                                                           
B4149003004FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                           
B4150001003ENTERAL FORMULA, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS, INCLUDES         EF complet w/intact nutrient39      A65-10             2130    4450                                                                       D                          O1C E      01986010120050101        N                           
B4150002004PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER,                                                                                                                                                                                                                                             
B4150003004ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                  
B4151001003ENTERAL FORMULAE; CATEGORY I; NATURAL INTACT PROTEIN/PROTEIN ISOLATES,          Enteral formulae cat1natural39      A65-10             2130    4450                                                                       D                          O1C E      0198601012005010120041231N                           
B4151002004ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                  
B4152001003ENTERAL FORMULA, NUTRITIONALLY COMPLETE, CALORICALLY DENSE (EQUAL TO OR GREATER EF calorie dense>/=1.5Kcal  39      A65-10             2130    4450                                                                       D                          O1C E      01984010120050101        N                           
B4152002004THAN 1.5 KCAL/ML) WITH INTACT NUTRIENTS, INCLUDES PROTEINS, FATS,                                                                                                                                                                                                                                                    
B4152003004CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH                                                                                                                                                                                                                                        
B4152004004AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                                       
B4153001003ENTERAL FORMULA, NUTRITIONALLY COMPLETE, HYDROLYZED PROTEINS (AMINO ACIDS AND   EF hydrolyzed/amino acids   39      A65-10             2130    4450                                                                       D                          O1C E      01986010120050101        N                           
B4153002004PEPTIDE CHAIN), INCLUDES FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY                                                                                                                                                                                                                                             
B4153003004INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1                                                                                                                                                                                                                                        
B4153004004UNIT                                                                                                                                                                                                                                                                                                                 
B4154001003ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS, EXCLUDES  EF spec metabolic noninherit39      A65-10             2130    4450                                                                       D                          O1C E      01984010120050101        N                           
B4154002004INHERITED DISEASE OF METABOLISM, INCLUDES ALTERED COMPOSITION OF PROTEINS,                                                                                                                                                                                                                                           
B4154003004FATS, CARBOHYDRATES, VITAMINS AND/OR MINERALS, MAY INCLUDE FIBER, ADMINISTERED                                                                                                                                                                                                                                       
B4154004004THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                               
B4155001003ENTERAL FORMULA, NUTRITIONALLY INCOMPLETE/MODULAR NUTRIENTS, INCLUDES SPECIFIC  EF incomplete/modular       39      A65-10             2130    4450                                                                       D                          O1C E      01986010120050101        N                           
B4155002004NUTRIENTS, CARBOHYDRATES (E.G. GLUCOSE POLYMERS), PROTEINS/AMINO ACIDS (E.G.                                                                                                                                                                                                                                         
B4155003004GLUTAMINE, ARGININE), FAT (E.G. MEDIUM CHAIN TRIGLYCERIDES) OR COMBINATION,                                                                                                                                                                                                                                          
B4155004004ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                  
B4156001003ENTERAL FORMULAE; CATEGORY VI; STANDARDIZED NUTRIENTS, ADMINISTERED THROUGH AN  Enteral formulae category vi39      A65-10             2130    4450                                                                       D                          O1C E      0198601012005010120041231N                           
B4156002004ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                                          
B4157001003ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS FOR        EF special metabolic inherit39      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4157002004INHERITED DISEASE OF METABOLISM, INCLUDES PROTEINS, FATS, CARBOHYDRATES,                                                                                                                                                                                                                                             
B4157003004VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL                                                                                                                                                                                                                                            
B4157004004FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                                                  
B4158001003ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS,  EF ped complete intact nut  46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4158002004INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE                                                                                                                                                                                                                                           
B4158003004FIBER AND/OR IRON, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES =                                                                                                                                                                                                                                      
B41580040041 UNIT                                                                                                                                                                                                                                                                                                               
B4159001003ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE SOY BASED WITH INTACT   EF ped complete soy based   46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4159002004NUTRIENTS, INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY                                                                                                                                                                                                                                        
B4159003004INCLUDE FIBER AND/OR IRON, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100                                                                                                                                                                                                                                         
B4159004004CALORIES = 1 UNIT                                                                                                                                                                                                                                                                                                    
B4160001003ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE CALORICALLY DENSE       EF ped caloric dense>/=0.7kc46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4160002004(EQUAL TO OR GREATER THAN 0.7 KCAL/ML) WITH INTACT NUTRIENTS, INCLUDES                                                                                                                                                                                                                                               
B4160003004PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER,                                                                                                                                                                                                                                             
B4160004004ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                                  
B4161001003ENTERAL FORMULA, FOR PEDIATRICS, HYDROLYZED/AMINO ACIDS AND PEPTIDE CHAIN       EF ped hydrolyzed/amino acid46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4161002004PROTEINS, INCLUDES FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE                                                                                                                                                                                                                                           
B4161003004FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT                                                                                                                                                                                                                                           
B4162001003ENTERAL FORMULA, FOR PEDIATRICS, SPECIAL METABOLIC NEEDS FOR INHERITED DISEASE  EF ped specmetabolic inherit46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4162002004OF METABOLISM, INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS,                                                                                                                                                                                                                                        
B4162003004MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES =                                                                                                                                                                                                                                      
B41620040041 UNIT                                                                                                                                                                                                                                                                                                               
B4164001003PARENTERAL NUTRITION SOLUTION:  CARBOHYDRATES (DEXTROSE), 50% OR LESS (500 ML = Parenteral 50% dextrose solu39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B41640020041 UNIT) - HOMEMIX                                                                                                                                                                                                                                                                                                    
B4168001003PARENTERAL NUTRITION SOLUTION; AMINO ACID, 3.5%, (500 ML = 1 UNIT) - HOMEMIX    Parenteral sol amino acid 3.39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N                           
B4172001003PARENTERAL NUTRITION SOLUTION; AMINO ACID, 5.5% THROUGH 7%, (500 ML = 1 UNIT) - Parenteral sol amino acid 5.39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N                           
B4172002004HOMEMIX                                                                                                                                                                                                                                                                                                              
B4176001003PARENTERAL NUTRITION SOLUTION; AMINO ACID, 7% THROUGH 8.5%, (500 ML = 1 UNIT) - Parenteral sol amino acid 7-39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4176002004HOMEMIX                                                                                                                                                                                                                                                                                                              
B4178001003PARENTERAL NUTRITION SOLUTION: AMINO ACID, GREATER THAN 8.5% (500 ML = 1 UNIT)  Parenteral sol amino acid > 39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4178002004- HOMEMIX                                                                                                                                                                                                                                                                                                            
B4180001003PARENTERAL NUTRITION SOLUTION; CARBOHYDRATES (DEXTROSE), GREATER THAN 50% (500  Parenteral sol carb > 50%   39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4180002004ML=1 UNIT) - HOMEMIX                                                                                                                                                                                                                                                                                                 
B4184001003PARENTERAL NUTRITION SOLUTION; LIPIDS, 10% WITH ADMINISTRATION SET (500 ML = 1  Parenteral sol lipids 10%   39      A65-10             2130    4450                                                                       D                          O1C E      0198401012006010120051231D                           
B4184002004UNIT)                                                                                                                                                                                                                                                                                                                
B4185001003PARENTERAL NUTRITION SOLUTION, PER 10 GRAMS LIPIDS                              Parenteral sol 10 gm lipids 39      A                                                                                                     D                      0126O1C E      02006010120060101        A                           
B4186001003PARENTERAL NUTRITION SOLUTION, LIPIDS, 20% WITH ADMINISTRATION SET (500 ML = 1  Parenteral sol lipids 20%   39      A65-10             2130    4450                                                                       D                          O1C E      0198601012006010120051231D                           
B4186002004UNIT)                                                                                                                                                                                                                                                                                                                
B4189001003PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol amino acid & 39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4189002004ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B4189003004STRENGTH, 10 TO 51 GRAMS OF PROTEIN - PREMIX                                                                                                                                                                                                                                                                         
B4193001003PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol 52-73 gm prot39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4193002004ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B4193003004STRENGTH, 52 TO 73 GRAMS OF PROTEIN - PREMIX                                                                                                                                                                                                                                                                         
B4197001003PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol 74-100 gm pro39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4197002004ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH,                                                                                                                                                                                                                                      
B419700300474 TO 100 GRAMS OF PROTEIN - PREMIX                                                                                                                                                                                                                                                                                  
B4199001003PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol > 100gm prote39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4199002004ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH,                                                                                                                                                                                                                                      
B4199003004OVER 100 GRAMS OF PROTEIN - PREMIX                                                                                                                                                                                                                                                                                   
B4216001003PARENTERAL NUTRITION; ADDITIVES (VITAMINS, TRACE ELEMENTS, HEPARIN,             Parenteral nutrition additiv39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N                           
B4216002004ELECTROLYTES) HOMEMIX PER DAY                                                                                                                                                                                                                                                                                        
B4220001003PARENTERAL NUTRITION SUPPLY KIT; PREMIX, PER DAY                                Parenteral supply kit premix39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N                           
B4222001003PARENTERAL NUTRITION SUPPLY KIT; HOME MIX, PER DAY                              Parenteral supply kit homemi39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4224001003PARENTERAL NUTRITION ADMINISTRATION KIT, PER DAY                                Parenteral administration ki39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B5000001003PARENTERAL NUTRITION SOLUTION:  COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH    Parenteral sol renal-amirosy39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B5000002004ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B5000003004STRENGTH, RENAL - AMIROSYN RF, NEPHRAMINE, RENAMINE - PREMIX                                                                                                                                                                                                                                                         
B5100001003PARENTERAL NUTRITION SOLUTION: COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH     Parenteral sol hepatic-fream39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B5100002004ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B5100003004STRENGTH, HEPATIC - FREAMINE HBC, HEPATAMINE - PREMIX                                                                                                                                                                                                                                                                
B5200001003PARENTERAL NUTRITION SOLUTION:  COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH    Parenteral sol stres-brnch c39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B5200002004ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY                                                                                                                                                                                                                                               
B5200003004STRENGTH, STRESS - BRANCH CHAIN AMINO ACIDS - PREMIX                                                                                                                                                                                                                                                                 
B9000001003ENTERAL NUTRITION INFUSION PUMP - WITHOUT ALARM                                 Enter infusion pump w/o alrm39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N                           
B9002001003ENTERAL NUTRITION INFUSION PUMP - WITH ALARM                                    Enteral infusion pump w/ ala39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N                           
B9004001003PARENTERAL NUTRITION INFUSION PUMP, PORTABLE                                    Parenteral infus pump portab39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N                           
B9006001003PARENTERAL NUTRITION INFUSION PUMP, STATIONARY                                  Parenteral infus pump statio39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N                           
B9998001003NOC FOR ENTERAL SUPPLIES                                                        Enteral supp not otherwise c57      A65-10             2130    4450                                                                       D                          O1C E      01985010119960101        N                           
B9999001003NOC FOR PARENTERAL SUPPLIES                                                     Parenteral supp not othrws c57      A65-10             2130    4450                                                                       D                          O1C E      01985010119960101        N                           
C1010001003WHOLE BLOOD OR RED BLOOD CELLS, LEUKOREDUCED, CMV NEGATIVE, EACH UNIT           Blood, L/R, CMV-NEG         53      A                                          1833(T)                                                    D                      0093T1H 0      0200008012004010120031231N                           
C1011001003PLATELET, HLA-MATCHED LEUKOREDUCED, APHERESIS/PHERESIS, EACH UNIT               Platelets, HLA-m, L/R, unit 53      A                                          1833(T)                                                    D                      0093T1H 0      0200008012004010120031231N                           
C1012001003PLATELET CONCENTRATE, LEUKOREDUCED, IRRADIATED, EACH UNIT                       PLATELET CONC, L/R, Irrad   53      A                                          1833(T)                           P9033                    D                      0093D1A 9      0200008012003010120021231N                           
C1013001003PLATELET CONCENTRATE, LEUKOREDUCED, EACH UNIT                                   PLATELET CONC, L/R, Unit    53      A                                          1833(T)                           P9031                    D                      0093D1A 9      0200008012003010120021231N                           
C1014001003PLATELET, LEUKOREDUCED, APHERESIS/PHERESIS, EACH UNIT                           Platelet,Aph/Pher, L/R, unit53      A                                          1833(T)                           P9035                    D                      0093D1A 9      0200008012003010120021231N                           
C1015001003PLATELETS, PHERESIS, LEUKOCYTE-REDUCED, CMV NEGATIVE, IRRADIATED, EACH UNIT     Plt, pher,L/R,CMV, irrad    53      A                                          1833(t)                                                    D                      0093T1H 0      0200301012004010120031231N                           
C1016001003WHOLE BLOOD OR RED BLOOD CELLS, LEUKOREDUCED, FROZEN, DEGLYCEROL, WASHED, EACH  BLOOD,L/R,FROZ/DEGLY/Washed 53      A                                          1833(T)                                                    D                      0093T1H 0      0200008012004010120031231N                           
C1016002004UNIT                                                                                                                                                                                                                                                                                                                 
C1017001003PLATELET, LEUKOREDUCED, CMV-NEGATIVE, APHERESIS/PHERESIS, EACH UNIT             Plt, APH/PHER,L/R,CMV-NEG   53      A                                          1833(T)                                                    D                      0093T1H 0      0200008012004010120031231N                           
C1018001003WHOLE BLOOD, LEUKOREDUCED, IRRADIATED, EACH UNIT                                Blood, L/R, IRRADIATED      53      A                                          1833(T)                                                    D                      0093T1H 0      0200008012004010120031231N                           
C1020001003RED BLOOD CELLS, FROZEN/DEGLYCEROLIZED/WASHED, LEUKOCYTE-REDUCED, IRRADIATED,   RBC, frz/deg/wsh, L/R, irrad53      A                                          1833(T)                                                    D                      0093T1H 0      0200301012004010120031231N                           
C1020002004EACH UNIT                                                                                                                                                                                                                                                                                                            
C1021001003RED BLOOD CELLS, LEUKOCYTE-REDUCED, CMV NEGATIVE, IRRADIATED, EACH UNIT         RBC, L/R, CMV neg, irrad    53      A                                          1833(T)                                                    D                      0093T1H 0      0200301012004010120031231N                           
C1022001003PLASMA, FROZEN WITHIN 24 HOURS OF COLLECTION, EACH UNIT                         Plasma, frz within 24 hour  53      A                                          1833(T)                                                    D                      0093T1H 9      0200301012004010120031231N                           
C1058001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M oxidronate, per vial 53      A                                          1833(T)                           Q3009                    D                      0093I1E 4      0200201012003010120021231N                           
C1058002004OXIDRONATE, PER VIAL                                                                                                                                                                                                                                                                                                 
C1064001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, SODIUM IODIDE I-131,   I-131 cap, each add mCi     53      A                                          1833(T)                                                    D                      0093I1E 4      0200201012003010120021231N                           
C1064002004CAPSULE, EACH ADDITIONAL MCI                                                                                                                                                                                                                                                                                         
C1065001003SUPPLY OF RADIOPHARMACUETICAL THERAPEUTIC IMAGING AGENT, SODIUM IODIDE I-131,   I-131 sol, each add mCi     53      A                                          1833(T)                                                    D                      0093I1E 4      0200201012003010120021231N                           
C1065002004SOLUTION, EACH ADDITIONAL MCI                                                                                                                                                                                                                                                                                        
C1066001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 SATUMOMAB    IN 111 satumomab pendetide  53      A                                          1833(T)                           A4642                    D                      0093I1E 4      0200201012003010120021231N                           
C1066002004PENDETIDE, PER VIAL                                                                                                                                                                                                                                                                                                  
C1079001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CYANOCOBALAMIN CO       CO 57/58 per 0.5 uCi        53      A                                          1833(T)                           A9546                    D                      0093I1E 4      0200008012006010120051231D                           
C107900200457/58, PER 0.5 MICROCURIE                                                                                                                                                                                                                                                                                            
C1080001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER  I-131 tositumomab, dx       53      A                                          1833T                             A9544                    D                          I1E 4      0200401012006010120051231D                           
C1080002004DOSE                                                                                                                                                                                                                                                                                                                 
C1081001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER I-131 tositumomab, tx       53      A                                          1833T                             A9545                    D                      0093I1E 6      0200401012006010120051231D                           
C1081002004DOSE                                                                                                                                                                                                                                                                                                                 
C1082001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB  In-111 ibritumomab tiuxetan 53      A                                          1833T                             A9542                    D                      0093I1E 4      0200401012006010120051231D                           
C1082002004TIUXETAN, PER DOSE                                                                                                                                                                                                                                                                                                   
C1083001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, YTTRIUM 90 IBRITUMOMAB Yttrium 90 ibritumomab tiuxe53      A                                          1833T                             A9543                    D                      0093I1E 6      0200401012006010120051231D                           
C1083002004TIUXETAN, PER DOSE                                                                                                                                                                                                                                                                                                   
C1087001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM IODIDE 1-123 PER I-123 per 100 uCi           53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012003010120021231N                           
C1087002004100 MICROCURIES                                                                                                                                                                                                                                                                                                      
C1088001003LASER OPTIC TREATMENT SYSTEM, INDIGO LASEROPTIC TREATMENT SYSTEM                LASER OPTIC TR Sys          53      A                                          1833(T)                                                    D                      0093P1G 9      0200008012004010120031231N                           
C1091001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111              IN111 oxyquinoline,per0.5mCi53      A                                          1833(T)                           A9547                    D                      0093I1E 4      0200008012006010120051231D                           
C1091002004OXYQUINOLINE, PER 0.5 MILLICURIE                                                                                                                                                                                                                                                                                     
C1092001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 PENTETATE,   IN 111 pentetate per 0.5 mCi53      A                                          1833(T)                           A9548                    D                      0093I1E 4      0200008012006010120051231D                           
C1092002004PER 0.5 MILLICURIE                                                                                                                                                                                                                                                                                                   
C1093001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC99M fanolesomab           53      A                                          1833(T)                           A9566                    D                          I1F 4      0200501012006010120051231D                           
C1093002004FANOLESOMAB, PER DOSE (10 - 20 MCI)                                                                                                                                                                                                                                                                                  
C1094001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC99Malbumin aggr,per 1.0mCi53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012003010120021231N                           
C1094002004ALBUMIN AGGREGATED, PER 1.0 MILLICURIE                                                                                                                                                                                                                                                                               
C1096001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M EXAMETAZIME, PER Dose53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012003010120021231N                           
C1096002004EXAMETAZIME, PER DOSE                                                                                                                                                                                                                                                                                                
C1097001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M MEBROFENIN, PER Vial 53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012003010120021231N                           
C1097002004MEBROFENIN, PER VIAL                                                                                                                                                                                                                                                                                                 
C1098001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M PENTETATE, PER Vial  53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012003010120021231N                           
C1098002004PENTETATE, PER VIAL                                                                                                                                                                                                                                                                                                  
C1099001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M PYROPHOSPHATE,PER Via53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012003010120021231N                           
C1099002004PYROPHOSPHATE, PER VIAL                                                                                                                                                                                                                                                                                              
C1122001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       Tc 99M ARCITUMOMAB PER VIAL 53      A                                          1833(T)                           A9549                    D                      0093I1E 4      0200008012006010120051231D                           
C1122002004ARCITUMOMAB, PER VIAL                                                                                                                                                                                                                                                                                                
C1166001003INJECTION, CYTARABINE LIPOSOME, PER 10 MG                                       CYTARABINE LIPOSOMAL, 10 mg 53      A                                          1833(T)                                                    D                      0093O1E 1P     0200008012004010120031231N                           
C1167001003INJECTION, EPIRUBICIN HYDROCHLORIDE, 2 MG                                       EPIRUBICIN HCL, 2 mg        53      A                                          1833(T)                                                    D                      0093O1D 1P     0200008012004010120031231N                           
C1178001003INJECTION, BUSULFAN, PER 6 MG                                                   BUSULFAN IV, 6 Mg           51      A                                          1833(T)                                                    D                      0093O1D 1P     02000080120030701        N                           
C1188001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, SODIUM IODIDE I-131,   I-131 cap, per 1-5 mCi      53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012003010120021231N                           
C1188002004CAPSULE, PER INITIAL 1-5 MCI                                                                                                                                                                                                                                                                                         
C1200001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M Sodium Glucoheptonat 53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012006010120051231D                           
C1200002004SODIUM GLUCOHEPTONATE, PER VIAL                                                                                                                                                                                                                                                                                      
C1201001003SUPPLY OF RADIOPHARMACEUTICAL  DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M      TC 99M SUCCIMER, PER Vial   53      A                                          1833(T)                           A9551                    D                      0093I1E 4      0200008012006010120051231D                           
C1201002004SUCCIMER, PER VIAL                                                                                                                                                                                                                                                                                                   
C1202001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       TC 99M SULFUR COLLOID, Vial 53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012003010120021231N                           
C1202002004SULFUR COLLOID, PER DOSE                                                                                                                                                                                                                                                                                             
C1207001003OCTREOTIDE ACETATE, 1 MG                                                        OCTREOTIDE ACETATE DEPOT 1mg53      A                                          1833(T)                                                    D                      0093O1E 9      0200008012003070120030630N                           
C1300001003HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL     HYPERBARIC Oxygen           53      A                                          1833(T)                                                    D                      0093P5E 9      02000080120030701        N                           
C1305001003GRAFTSKIN, PER 44 SQUARE CENTIMETERS                                            Apligraf                    53      A                                          1833(T)                           J7340                    D                      0093D1A 9      0200008012006010120051231D                           
C1348001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, SODIUM IODIDE I-131,   I-131 sol, per 1-6 mCi      53      A                                          1833(T)                                                    D                      0093I1E 4      0200008012003010120021231N                           
C1348002004SOLUTION, PER INITIAL 1-6 MCI                                                                                                                                                                                                                                                                                        
C1713001003ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE)     Anchor/screw bn/bn,tis/bn   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1714001003CATHETER, TRANSLUMINAL ATHERECTOMY, DIRECTIONAL                                 Cath, trans atherectomy, dir53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1715001003BRACHYTHERAPY NEEDLE                                                            Brachytherapy needle        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1716001003BRACHYTHERAPY SOURCE, GOLD 198, PER SOURCE                                      Brachytx source, Gold 198   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120050101        N                           
C1717001003BRACHYTHERAPY SOURCE, HIGH DOSE RATE IRIDIUM 192, PER SOURCE                    Brachytx source, HDR Ir-192 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120050101        N                           
C1718001003BRACHYTHERAPY SOURCE, IODINE 125, PER SOURCE                                    Brachytx source, Iodine 125 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120050101        N                           
C1719001003BRACHYTHERAPY SOURCE, NON-HIGH DOSE RATE IRIDIUM 192, PER SOURCE                Brachytx sour,Non-HDR Ir-19253      A                                          1833(T)                                                    D                          D1A 9S     02001040120050101        N                           
C1720001003BRACHYTHERAPY SOURCE, PALLADIUM 103, PER SOURCE                                 Brachytx sour, Palladium 10353      A                                          1833(T)                                                    D                          D1A 9S     02001040120050101        N                           
C1721001003CARDIOVERTER-DEFIBRILLATOR, DUAL CHAMBER (IMPLANTABLE)                          AICD, dual chamber          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1722001003CARDIOVERTER-DEFIBRILLATOR, SINGLE CHAMBER (IMPLANTABLE)                        AICD, single chamber        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1724001003CATHETER, TRANSLUMINAL ATHERECTOMY, ROTATIONAL                                  Cath, trans atherec,rotation53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1725001003CATHETER, TRANSLUMINAL ANGIOPLASTY, NON-LASER (MAY INCLUDE GUIDANCE,            Cath, translumin non-laser  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1725002004INFUSION/PERFUSION CAPABILITY)                                                                                                                                                                                                                                                                                       
C1726001003CATHETER, BALLOON DILATATION, NON-VASCULAR                                      Cath, bal dil, non-vascular 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1727001003CATHETER, BALLOON TISSUE DISSECTOR, NON-VASCULAR (INSERTABLE)                   Cath, bal tis dis, non-vas  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1728001003CATHETER, BRACHYTHERAPY SEED ADMINISTRATION                                     Cath, brachytx seed adm     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1729001003CATHETER, DRAINAGE                                                              Cath, drainage              53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1730001003CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (19 OR FEWER     Cath, EP, 19 or few elect   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1730002004ELECTRODES)                                                                                                                                                                                                                                                                                                          
C1731001003CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (20 OR MORE      Cath, EP, 20 or more elec   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1731002004ELECTRODES)                                                                                                                                                                                                                                                                                                          
C1732001003CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, 3D OR VECTOR MAPPING          Cath, EP, diag/abl, 3D/vect 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1733001003CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, OTHER THAN 3D OR VECTOR       Cath, EP, othr than cool-tip53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1733002004MAPPING, OTHER THAN COOL-TIP                                                                                                                                                                                                                                                                                         
C1750001003CATHETER, HEMODIALYSIS, LONG-TERM                                               Cath, hemodialysis,long-term53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1751001003CATHETER, INFUSION, INSERTED PERIPHERALLY, CENTRALLY OR MIDLINE (OTHER THAN     Cath, inf, per/cent/midline 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1751002004HEMODIALYSIS)                                                                                                                                                                                                                                                                                                        
C1752001003CATHETER, HEMODIALYSIS, SHORT-TERM                                              Cath,hemodialysis,short-term53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1753001003CATHETER, INTRAVASCULAR ULTRASOUND                                              Cath, intravas ultrasound   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1754001003CATHETER, INTRADISCAL                                                           Catheter, intradiscal       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1755001003CATHETER, INTRASPINAL                                                           Catheter, intraspinal       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1756001003CATHETER, PACING, TRANSESOPHAGEAL                                               Cath, pacing, transesoph    53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1757001003CATHETER, THROMBECTOMY/EMBOLECTOMY                                              Cath, thrombectomy/embolect 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1758001003CATHETER, URETERAL                                                              Catheter, ureteral          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1759001003CATHETER, INTRACARDIAC ECHOCARDIOGRAPHY                                         Cath, intra echocardiography53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1760001003CLOSURE DEVICE, VASCULAR (IMPLANTABLE/INSERTABLE)                               Closure dev, vasc           53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1762001003CONNECTIVE TISSUE, HUMAN (INCLUDES FASCIA LATA)                                 Conn tiss, human(inc fascia)53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1763001003CONNECTIVE TISSUE, NON-HUMAN (INCLUDES SYNTHETIC)                               Conn tiss, non-human        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1764001003EVENT RECORDER, CARDIAC (IMPLANTABLE)                                           Event recorder, cardiac     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1765001003ADHESION BARRIER                                                                Adhesion barrier            53      A                                          1833(T)                                                    D                          D1A 9S     02001070120010701        N                           
C1766001003INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, STEERABLE, OTHER Intro/sheath,strble,non-peel53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1766002004THAN PEEL-AWAY                                                                                                                                                                                                                                                                                                       
C1767001003GENERATOR, NEUROSTIMULATOR (IMPLANTABLE)                                        Generator, neurostim, imp   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1768001003GRAFT, VASCULAR                                                                 Graft, vascular             53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1769001003GUIDE WIRE                                                                      Guide wire                  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1770001003IMAGING COIL, MAGNETIC RESONANCE (INSERTABLE)                                   Imaging coil, MR, insertable53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1771001003REPAIR DEVICE, URINARY, INCONTINENCE, WITH SLING GRAFT                          Rep dev, urinary, w/sling   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1772001003INFUSION PUMP, PROGRAMMABLE (IMPLANTABLE)                                       Infusion pump, programmable 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1773001003RETRIEVAL DEVICE, INSERTABLE (USED TO RETRIEVE FRACTURED MEDICAL DEVICES)       Ret dev, insertable         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1774001003INJECTION, DARBEPOETIN ALFA (FOR NON ESRD USE), PER 1 MCG                       Darbepoetin alfa, non-esrd  53      A                                          1833(T)                                                    D                          O1E 9      0200201012004010120031231N                           
C1775001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, FLUORODEOXYGLUCOSE F18  FDG, per dose (4-40 mCi/ml) 53      A                                          1833(T)                           A9552                    D                          I2D 4      0200204012006010120051231D                           
C1775002004(2-DEOXY-2-[18F]FLUORO-D-GLUCOSE), PER DOSE (4-40 MCI/ML)                                                                                                                                                                                                                                                            
C1776001003JOINT DEVICE (IMPLANTABLE)                                                      Joint device (implantable)  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1777001003LEAD, CARDIOVERTER-DEFIBRILLATOR, ENDOCARDIAL SINGLE COIL (IMPLANTABLE)         Lead, AICD, endo single coil53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1778001003LEAD, NEUROSTIMULATOR (IMPLANTABLE)                                             Lead, neurostimulator       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1779001003LEAD, PACEMAKER, TRANSVENOUS VDD SINGLE PASS                                    Lead, pmkr, transvenous VDD 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1780001003LENS, INTRAOCULAR (NEW TECHNOLOGY)                                              Lens, intraocular (new tech)53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1781001003MESH (IMPLANTABLE)                                                              Mesh (implantable)          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1782001003MORCELLATOR                                                                     Morcellator                 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1783001003OCULAR IMPLANT, AQUEOUS DRAINAGE ASSIST DEVICE                                  Ocular imp, aqueous drain de53      A                                          1833(T)                                                    D                          D1A 9S     02002070120020701        N                           
C1784001003OCULAR DEVICE, INTRAOPERATIVE, DETACHED RETINA                                  Ocular dev, intraop, det ret53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1785001003PACEMAKER, DUAL CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)                          Pmkr, dual, rate-resp       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1786001003PACEMAKER, SINGLE CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)                        Pmkr, single, rate-resp     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1787001003PATIENT PROGRAMMER, NEUROSTIMULATOR                                             Patient progr, neurostim    53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1788001003PORT, INDWELLING (IMPLANTABLE)                                                  Port, indwelling, imp       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1789001003PROSTHESIS, BREAST (IMPLANTABLE)                                                Prosthesis, breast, imp     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1813001003PROSTHESIS, PENILE, INFLATABLE                                                  Prosthesis, penile, inflatab53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1814001003RETINAL TAMPONADE DEVICE, SILICONE OIL                                          Retinal tamp, silicone oil  53      A                                          1833t                                                      D                          D1A 9S     02003040120030401        N                           
C1815001003PROSTHESIS, URINARY SPHINCTER (IMPLANTABLE)                                     Pros, urinary sph, imp      53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1816001003RECEIVER AND/OR TRANSMITTER, NEUROSTIMULATOR (IMPLANTABLE)                      Receiver/transmitter, neuro 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1817001003SEPTAL DEFECT IMPLANT SYSTEM, INTRACARDIAC                                      Septal defect imp sys       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1818001003INTEGRATED KERATOPROSTHESIS                                                     Integrated keratoprosthesis 53      A                                          1833T                                                      D                          D1A 9S     02003070120030701        N                           
C1819001003SURGICAL TISSUE LOCALIZATION AND EXCISION DEVICE (IMPLANTABLE)                  Tissue localization-excision53      A                                          1833T                                                      D                      0093D1A 9S     02004010120040101        N                           
C1874001003STENT, COATED/COVERED, WITH DELIVERY SYSTEM                                     Stent, coated/cov w/del sys 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1875001003STENT, COATED/COVERED, WITHOUT DELIVERY SYSTEM                                  Stent, coated/cov w/o del sy53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1876001003STENT, NON-COATED/NON-COVERED, WITH DELIVERY SYSTEM                             Stent, non-coa/non-cov w/del53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1877001003STENT, NON-COATED/NON-COVERED, WITHOUT DELIVERY SYSTEM                          Stent, non-coat/cov w/o del 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1878001003MATERIAL FOR VOCAL CORD MEDIALIZATION, SYNTHETIC (IMPLANTABLE)                  Matrl for vocal cord        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1879001003TISSUE MARKER (IMPLANTABLE)                                                     Tissue marker, implantable  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1880001003VENA CAVA FILTER                                                                Vena cava filter            53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1881001003DIALYSIS ACCESS SYSTEM (IMPLANTABLE)                                            Dialysis access system      53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1882001003CARDIOVERTER-DEFIBRILLATOR, OTHER THAN SINGLE OR DUAL CHAMBER (IMPLANTABLE)     AICD, other than sing/dual  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1883001003ADAPTOR/EXTENSION, PACING LEAD OR NEUROSTIMULATOR LEAD (IMPLANTABLE)            Adapt/ext, pacing/neuro lead53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1884001003EMBOLIZATION PROTECTIVE SYSTEM                                                  Embolization Protect syst   53      A                                          1833T                                                      D                          D1A 9S     02003010120030101        N                           
C1885001003CATHETER, TRANSLUMINAL ANGIOPLASTY, LASER                                       Cath, translumin angio laser53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1887001003CATHETER, GUIDING (MAY INCLUDE INFUSION/PERFUSION CAPABILITY)                   Catheter, guiding           53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1888001003CATHETER, ABLATION, NON-CARDIAC, ENDOVASCULAR (IMPLANTABLE)                     Endovas non-cardiac abl cath53      A                                          1833(T)                                                    D                          D1A 9S     02002070120020701        N                           
C1891001003INFUSION PUMP, NON-PROGRAMMABLE, PERMANENT (IMPLANTABLE)                        Infusion pump,non-prog, perm53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1892001003INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE,     Intro/sheath,fixed,peel-away53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1892002004PEEL-AWAY                                                                                                                                                                                                                                                                                                            
C1893001003INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE,     Intro/sheath, fixed,non-peel53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1893002004OTHER THAN PEEL-AWAY                                                                                                                                                                                                                                                                                                 
C1894001003INTRODUCER/SHEATH, OTHE THAN GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL,        Intro/sheath, non-laser     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1894002004NON-LASER                                                                                                                                                                                                                                                                                                            
C1895001003LEAD, CARDIOVERTER-DEFIBRILLATOR, ENDOCARDIAL DUAL COIL (IMPLANTABLE)           Lead, AICD, endo dual coil  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1896001003LEAD, CARDIOVERTER-DEFIBRILLATOR, OTHER THAN ENDOCARDIAL SINGLE OR DUAL COIL    Lead, AICD, non sing/dual   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1896002004(IMPLANTABLE)                                                                                                                                                                                                                                                                                                        
C1897001003LEAD, NEUROSTIMULATOR TEST KIT (IMPLANTABLE)                                    Lead, neurostim test kit    53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1898001003LEAD, PACEMAKER, OTHER THAN TRANSVENOUS VDD SINGLE PASS                         Lead, pmkr, other than trans53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1899001003LEAD, PACEMAKER/CARDIOVERTER-DEFIBRILLATOR COMBINATION (IMPLANTABLE)            Lead, pmkr/AICD combination 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1900001003LEAD, LEFT VENTRICULAR CORONARY VENOUS SYSTEM                                   Lead, coronary venous       53      A                                          1833(T)                                                    D                          D1A 9S     02002070120020701        N                           
C2614001003PROBE, PERCUTANEOUS LUMBAR DISCECTOMY                                           Probe, perc lumb disc       53      A                                          1833(T)                                                    D                      0093D1A 9S     02003010120030101        N                           
C2615001003SEALANT, PULMONARY, LIQUID                                                      Sealant, pulmonary, liquid  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2616001003BRACHYTHERAPY SOURCE, YTTRIUM-90, PER SOURCE                                    Brachytx source, Yttrium-90 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120050101        N                           
C2617001003STENT, NON-CORONARY, TEMPORARY, WITHOUT DELIVERY SYSTEM                         Stent, non-cor, tem w/o del 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2618001003PROBE, CRYOABLATION                                                             Probe, cryoablation         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120010401        N                           
C2619001003PACEMAKER, DUAL CHAMBER, NON RATE-RESPONSIVE (IMPLANTABLE)                      Pmkr, dual, non rate-resp   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2620001003PACEMAKER, SINGLE CHAMBER, NON RATE-RESPONSIVE (IMPLANTABE)                     Pmkr, single, non rate-resp 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2621001003PACEMAKER, OTHER THAN SINGLE OR DUAL CHAMBER (IMPLANTABLE)                      Pmkr, other than sing/dual  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2622001003PROSTHESIS, PENILE, NON-INFLATABLE                                              Prosthesis, penile, non-inf 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2625001003STENT, NON-CORONARY, TEMPORARY, WITH DELIVERY SYSTEM                            Stent, non-cor, tem w/del sy53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2626001003INFUSION PUMP, NON-PROGRAMMABLE, TEMPORARY (IMPLANTABLE)                        Infusion pump, non-prog,temp53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2627001003CATHETER, SUPRAPUBIC/CYSTOSCOPIC                                                Cath, suprapubic/cystoscopic53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2628001003CATHETER, OCCLUSION                                                             Catheter, occlusion         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2629001003INTRODUCER/SHEATH, OTHER THAN GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, LASER Intro/sheath, laser         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2630001003CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, OTHER THAN 3D OR VECTOR       Cath, EP, cool-tip          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2630002004MAPPING, COOL-TIP                                                                                                                                                                                                                                                                                                    
C2631001003REPAIR DEVICE, URINARY, INCONTINENCE, WITHOUT SLING GRAFT                       Rep dev, urinary, w/o sling 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2632001003BRACHYTHERAPY SOLUTION, IODINE-125, PER MCI                                     Brachytx sol, I-125, per mCi53      A                                          1833(T)                                                    D                      0093D1A 9      02003010120030101        N                           
C2633001003BRACHYTHERAPY SOURCE, CESIUM-131, PER SOURCE                                    Brachytx source, Cesium-131 53      A                                          1833T                                                      D                      0093D1A 9S     02004010120050101        N                           
C2634001003BRACHYTHERAPY SOURCE, HIGH ACTIVITY, IODINE-125, GREATER THAN  1.01 MCI (NIST), Brachytx source, HA, I-125  53      A                                          1833(T)                                                    D                          D1A 9      02005010120050101        C                           
C2634002004PER SOURCE                                                                                                                                                                                                                                                                                                           
C2635001003BRACHYTHERAPY SOURCE, HIGH ACTIVITY, PALADIUM-103, GREATER THAN  2.2 MCI        Brachytx source, HA, P-103  53      A                                          1833(T)                                                    D                          D1A 9      02005010120050101        C                           
C2635002004(NIST), PER SOURCE                                                                                                                                                                                                                                                                                                   
C2636001003BRACHYTHERAPY LINEAR SOURCE, PALADIUM-103, PER 1 MM                             Brachytx linear source,P-10353      A                                          1833(T)                                                    D                          D1A 9      02005010120050101        N                           
C2637001003BRACHYTHERAPY SOURCE, YTTERBIUM-169, PER SOURCE                                 Brachytx, Ytterbium-169     53      A                                          1833(T)                                                    D                          I1E 4      02005100120051001        A                           
C8900001003MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, ABDOMEN                           MRA w/cont, abd             53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8901001003MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, ABDOMEN                        MRA w/o cont, abd           53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8902001003MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,      MRA w/o fol w/cont, abd     53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8902002004ABDOMEN                                                                                                                                                                                                                                                                                                              
C8903001003MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; UNILATERAL                    MRI w/cont, breast,  uni    53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8904001003MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; UNILATERAL                 MRI w/o cont, breast, uni   53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8905001003MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST;  MRI w/o fol w/cont, brst, un53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8905002004UNILATERAL                                                                                                                                                                                                                                                                                                           
C8906001003MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; BILATERAL                     MRI w/cont, breast,  bi     53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8907001003MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; BILATERAL                  MRI w/o cont, breast, bi    53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8908001003MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST;  MRI w/o fol w/cont, breast, 53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8908002004BILATERAL                                                                                                                                                                                                                                                                                                            
C8909001003MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, CHEST (EXCLUDING MYOCARDIUM)      MRA w/cont, chest           53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8910001003MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, CHEST (EXCLUDING MYOCARDIUM)   MRA w/o cont, chest         53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8911001003MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,      MRA w/o fol w/cont, chest   53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8911002004CHEST (EXCLUDING MYOCARDIUM)                                                                                                                                                                                                                                                                                         
C8912001003MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, LOWER EXTREMITY                   MRA w/cont, lwr ext         53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8913001003MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, LOWER EXTREMITY                MRA w/o cont, lwr ext       53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8914001003MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,      MRA w/o fol w/cont, lwr ext 53      A                                          1833(t)(2)                                                 D                          I2D 4      02001100120011001        N                           
C8914002004LOWER EXTREMITY                                                                                                                                                                                                                                                                                                      
C8918001003MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, PELVIS                            MRA w/cont, pelvis          53      A                                          430 BIPA                                                   D                          I2D 4      02003070120030701        N                           
C8919001003MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, PELVIS                         MRA w/o cont, pelvis        53      A                                          430 BIPA                                                   D                          I2D 4      02003070120030701        N                           
C8920001003MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,      MRA w/o fol w/cont, pelvis  53      A                                          430 BIPA                                                   D                          I2D 4      02003070120030701        N                           
C8920002004PELVIS                                                                                                                                                                                                                                                                                                               
C9000001003INJECTION, SODIUM CHROMATE CR51, PER 0.25 MCI                                   Na chromateCr51, per 0.25mCi53      A                                          1833(t)                           A9553                    D                      0093O1E 1      0200010012006010120051231D                           
C9003001003PALIVIZUMAB-RSV-IGM, PER 50 MG                                                  Palivizumab, per 50 mg      53      A                                          1833(t)                                                    D                      0093O1E 1      02000100120001001        N                           
C9007001003BACLOFEN INTRATHECAL SCREENING KIT (1 AMP)                                      Baclofen Intrathecal kit-1am53      A                                          1833(t)                           J0476                    D                      0093O1E 1      0200010012006010120051231D                           
C9008001003BACLOFEN INTRATHECAL REFILL KIT, PER 500 MCG                                    Baclofen Refill Kit-500mcg  53      A                                          1833(t)                           J0475                    D                      0093O1E 1      0200010012006010120051231D                           
C9009001003BACLOFEN INTRATHECAL REFILL KIT, PER 2000 MCG                                   Baclofen Refill Kit-2000mcg 53      A                                          1833(t)                           J0475                    D                      0093O1E 1      0200010012006010120051231D                           
C9010001003BACLOFEN INTRATHECAL REFILL KIT, PER 4000 MCG                                   Baclofen Refill Kit--4000mcg53      A                                          1833(T)                                                    D                      0093O1E 1      0200010012004010120031231N                           
C9013001003SUPPLY OF CO 57 COBALTOUS CHLORIDE, RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENTCo 57 cobaltous chloride    53      A                                          1833(t)                                                    D                      0093O1E 1      0200104012006010120051231D                           
C9019001003INJECTION, CASPOFUNGIN ACETATE, 5 MG                                            Caspofungin acetate, 5 mg   53      A                                          1833(T)                           J0637                    D                          O1E 1      0200107012003010120021231N                           
C9020001003SIROLIMUS TABLET, 1 MG                                                          Sirolimus tablet, 1 mg      53      A                                          1833(T)                           J7520                    D                          O1E 1      0200107012003010220020101N                           
C9100001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, IODINATED I-131         Iodinated I-131 Albumin     53      A                                          1833(t)                                                    D                      0093I1E 4      0200010012003010120021231N                           
C9100002004ALBUMIN, PER MCI                                                                                                                                                                                                                                                                                                     
C9102001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, 51 SODIUM CHROMATE, PER 51 Na Chromate, 50mCi       53      A                                          1833(t)                           A9553                    D                      0093I1E 4      0200010012006010120051231D                           
C910200200450 MCI                                                                                                                                                                                                                                                                                                               
C9103001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM IOTHALAMATE      Na Iothalamate I-125, 10 uCi53      A                                          1833(t)                           A9554                    D                      0093I1E 4      0200010012006010120051231D                           
C9103002004I-125 INJECTION, PER 10 UCI                                                                                                                                                                                                                                                                                          
C9105001003INJECTION, HEPATITIS B IMMUNE GLOBULIN, PER 1 ML                                Hep B imm glob, per 1 ml    53      A                                          1833(t)                           90371                    D                      0093O1E 1      0200010012006010120051231D                           
C9108001003INJECTION, THYROTROPIN ALPHA, 1.1 MG                                            Thyrotropin alfa, 1.1 mg    53      A                                          1833(T)                           J3240                    D                          O1E 9      0200101012003010120021231N                           
C9109001003INJECTION, TIROFIBAN HYDROCHLORIDE, 6.25 MG                                     Tirofiban hcl, 6.25 mg      53      A                                          1833(T)                           J3246                    D                          O1E 9      0200101012005010120041231N                           
C9110001003INJECTION, ALEMTUZUMAB, PER 10 MG/ ML                                           Alemtuzumab, per 10mg/ml    53      A                                          1833(T)                           J9010                    D                          D1A 9S     0200110012003010120021231N                           
C9111001003INJECTION, BIVALIRUDIN, 250 MG PER VIAL                                         Inj, bivalirudin, 250mg vial53      A                                          1833(t)                                                    D                          O1E 9      0200201012004010120031231N                           
C9112001003INJECTION, PERFLUTREN LIPID MICROSPHERE, PER 2 ML VIAL                          Perflutren lipid micro, 2ml 53      A                                          1833(t)                           Q9957                    D                          I1E 9      0200201012006010120051231D                           
C9113001003INJECTION, PANTOPRAZOLE SODIUM, PER VIAL                                        Inj pantoprazole sodium, via53      A                                          1833(T)                                                    D                          O1E 9      02002010120020101        N                           
C9114001003INJECTION, NESIRITIDE, PER 1.5 MG VIAL                                          Nesiritide, per 1.5 mg vial 53      A                                          1833(T)                           J2324                    D                          O1E 9      0200201012003010120021231N                           
C9115001003INJECTION, ZOLEDRONIC ACID, PER 2 MG                                            Inj, zoledronic acid, 2 mg  53      A                                          1833(T)                           J3487                    D                          O1E 9      0200201012003010120021231N                           
C9116001003INJECTION, ERTAPENEM SODIUM, PER 1 GRAM VIAL                                    Ertapenem sodium, per 1 gm  53      A                                          1833(t)                                                    D                      0093O1E 9      0200210012004010120031231N                           
C9117001003INJECTION, YTTRIUM-90 IBRITUMOMAB TIUXETAN, PER MCI                             Y-90 ibritumomab tiuxetan   53      A                                          1833(t)                           A9523                    D                      0093O1E 9      0200210012003010120021231N                           
C9118001003INJECTION, INDIUM-111 IBRITUMOMAB TIUXETAN, PER MCI                             IN-111 ibritumomab tiuxetan 53      A                                          1833(t)                           A9522                    D                      0093O1E 9      0200210012003010120021231N                           
C9119001003INJECTION, PEGFILGRASTIM, PER 6 MG SINGLE DOSE VIAL                             Injection, pegfilgrastim    53      A                                          1833(t)                                                    D                      0093O1E 9      0200210012003070120030630N                           
C9120001003INJECTION, FULVESTRANT, PER 50 MG                                               Injection, fulvestrant      53      A                                          1833(T)                                                    D                      0093O1E 1P     0200301012004010120031231N                           
C9121001003INJECTION, ARGATROBAN, PER 5 MG                                                 Injection, argatroban       53      A                                          1833(T)                                                    D                      0093O1E 1P     02003010120030101        N                           
C9123001003HUMAN FIBROBLAST DERIVED TEMPORARY SKIN SUBSTITUTE, PER 247 SQUARE CENTIMETERS  Transcyte, per 247 sq cm    53      A                                          1833T                                                      D                      0093D1A 9S     0200307012006010120051231D                           
C9124001003INJECTION, DAPTOMYCIN, PER 1 MG                                                 Injection, daptomycin       53      A                                          1833(T)                           J0878                    D                          O1E 1      0200401012005010120041231N                           
C9125001003INJECTION, RISPERIDONE, PER 12.5 MG                                             Injection, risperidone      53      A                                          1833(T)                           J2794                    D                          O1E 1      0200401012005010120041231N                           
C9126001003INJECTION, NATALIZUMAB, PER 5 MG                                                Injection, natalizumab      53      A                                          1833(T)                           Q4079                    D                      0093O1E 9      0200411232005040120050331D                           
C9127001003INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, PER 1 MG                         Paclitaxel protein pr       53      A                                          1833(T)                           J9264                    D                          O1D 1      0200501072006010120051231D                           
C9128001003INJECTION, PEGAPTANIB SODIUM, PER 0.3 MG                                        Inj pegaptanib sodium       53      A                                          1833(T)                           J2503                    D                          O1E 9      0200412172006010120051231D                           
C9129001003INJECTION, CLOFARABINE, PER 1 MG                                                Inj clofarabine             53      A                                          621MMA                            J9027                    D                          O1E 9      0200507012006010120051231D                           
C9200001003BILAYERED CELLULAR MATRIX, PER 36 SQUARE CENTIMETERS                            Orcel, per 36 cm2           53      A                                          1833(T)                           J7340                    D                          D1A 9      0200201012006010120051231D                           
C9201001003HUMAN FIBROBLAST-DERIVED DERMAL SUBSTITUTE, PER 37.5 SQUARE CENTIMETERS         Dermagraft, per 37.5 sq cm  53      A                                          1833(T)                           J7342                    D                          D1A 9      0200201012006010120051231D                           
C9202001003INJECTION, SUSPENSION OF MICROSPHERES OF HUMAN SERUM ALBUMIN WITH               Octafluoropropane           53      A                                          1833T                             Q9956                    D                          I1E 9      0200304012006010120051231D                           
C9202002004OCTAFLUOROPROPANE, PER 3 ML                                                                                                                                                                                                                                                                                          
C9203001003INJECTION, PERFLEXANE LIPID MICROSPHERES, PER 10 ML VIAL                        Perflexane lipid micro      53      A                                          1833T                             Q9955                    D                          I1E 9      0200304012006010120051231D                           
C9204001003INJECTION, ZIPRASIDONE MESYLATE, PER 20 MG                                      Ziprasidone mesylate        53      A                                          1833T                                                      D                          O1E 9      0200304012004010120031231N                           
C9205001003INJECTION, OXALIPLATIN, PER 5 MG                                                Oxaliplatin                 53      A                                          1833T                             J9263                    D                          O1D 9      0200307012006010120051231D                           
C9206001003COLLAGEN-GLYCOSAMINOGLYCAN BILAYER MATRIX, PER CM2                              Integra, per cm2            53      A                                          1833(T)                           J7343                    D                          D1A 9      0200501012006010120051231D                           
C9207001003INJECTION, BORTEZOMIB, PER 3.5 MG                                               Injection, bortezomib       53      A                                          1833T                             J9041                    D                      0093O1E 9      0200310012005010120041231N                           
C9208001003INJECTION, AGALSIDASE BETA, PER 1 MG                                            Injection, agalsidase beta  53      A                                          1833T                             J0180                    D                      0093O1E 9      0200310012005010120041231N                           
C9209001003INJECTION, LARONIDASE, PER 2.9 MG                                               Injection, laronidase       53      A                                          1833T                             J1931                    D                      0093O1E 9      0200310012005010120041231N                           
C9210001003INJECTION, PALONOSETRON HYDROCHLORIDE, PER 250 MCG                              Injection, palonosetron HCl 53      A                                          1833T                             J2469                    D                      0093O1E 9      0200401012005010120041231N                           
C9211001003INJECTION, ALEFACEPT, FOR INTRAVENOUS USE, PER 7.5 MG                           Inj, alefacept, IV          53      A                                          1833T                             J0215                    D                      0093O1E 9      0200401012006010120051231D                           
C9212001003INJECTION, ALEFACEPT, FOR INTRAMUSCULAR USE, PER 7.5 MG                         Inj, alefacept, IM          53      A                                          1833T                             J0215                    D                      0093O1E 9G     0200401012006010120051231D                           
C9213001003INJECTION, PEMETREXED, PER 10 MG                                                Injection, pemetrexed       53      A                                          621MMA                            J9305                    D                          O1D 1      0200402042005010120041231N                           
C9214001003INJECTION, BEVACIZUMAB, PER 10 MG                                               Injection, bevacizumab      53      A                                          621MMA                            J9035                    D                          O1D 1      0200402262005010120041231N                           
C9215001003INJECTION, CETUXIMAB, PER 10 MG                                                 Injection, cetuximab        53      A                                          621MMA                            J9055                    D                          O1D 1      0200402122005010120041231N                           
C9216001003INJECTION, ABARELIX FOR INJECTABLE SUSPENSION, PER 10 MG                        Abarelix, inject suspension 53      A                                          621MMA                            J0128                    D                          O1D 1      0200401012005010120041231N                           
C9217001003INJECTION, OMALIZUMAB, PER 5 MG                                                 Injection, omalizumab       53      A                                          621MMA                            J2357                    D                          O1E 1      0200401012005010120041231N                           
C9218001003INJECTION, AZACITIDINE, PER 1 MG                                                Injection, azacitidine      53      A                                          MMA-Sec621                        J9025                    D                          O1E 9      0200405192006010120051231D                           
C9219001003MYCOPHENOLIC ACID, ORAL, PER 180 MG                                             Mycophenolic acid, oral     53      A                                          MMA-Sec621                        J7518                    D                          O1E 9G     0200402272005010120041231N                           
C9220001003SODIUM HYALURONATE PER 30 MG DOSE, FOR INTRA-ARTICULAR INJECTION                Sodium hyaluronate          53      A                                          1833(t)                                                    D                          O1E 9      02005010120050101        N                           
C9221001003ACELLULAR DERMAL TISSUE MATRIX, PER 16CM2                                       Graftjacket Reg Matrix      53      A                                          1833(t)                                                    D                          D1A 9      02005010120050101        N                           
C9222001003DECELLULARIZED SOFT TISSUE SCAFFOLD, PER 1 CC                                   Graftjacket SftTis          53      A                                          1833(t)                                                    D                          D1A 9      02005010120050101        N                           
C9223001003INJECTION, 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     0200504012006010120051231D                           
C9223002004REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270)                                                                                                                                                                                                                                                         
C9224001003INJECTION, GALSULFASE, PER 5 MG                                                 Injection, galsulfase       51      A                                          621MMA                                                     D                          O1E 9      02005053120050531        A                           
C9225001003INJECTION, FLUOCINOLONE  ACETONIDE INTRAVITREAL IMPLANT, PER 0.59 MG            Fluocinolone acetonide      53      A                                          621MMA                                                     D                          O1E 9      02005100120051001        A                           
C9226001003INJECTION, ZICONOTIDE FOR INTRATHECAL INFUSION, PER 5 MCG                       Ziconotide intrathecal inf  53      A                                          621MMA                            J2278                    D                          D1G 9      0200510012006010120051231D                           
C9399001003UNCLASSIFIED DRUGS OR BIOLOGICALS                                               Unclassified drugs or biolog53      A                                          621MMA                                                     D                          O1E 1      02004010120040101        N                           
C9400001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, THALLOUS CHLORIDE TL    Thallous chloride, brand    53      A                                          621 of MMA                        A9505                    D                          I1E 4      0200401012006010120051231D                           
C9400002004201, BRAND NAME, PER MCI                                                                                                                                                                                                                                                                                             
C9401001003SUPPLY OF THERAPEUTIC RADIOPHARMACEUTICAL, STRONTIUM-89 CHLORIDE, BRAND NAME,   Strontium-89 chloride,brand 53      A                                          621MMA                            A9600                    D                          I1E 6      0200401012006010120051231D                           
C9401002004PER MCI                                                                                                                                                                                                                                                                                                              
C9402001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 SODIUM IODIDE    Th I131 so iodide cap, brand53      A                                          621 of MMA                        A9517                    D                          I1E 4      0200401012006010120051231D                           
C9402002004CAPSULE, BRAND NAME, PER MCI                                                                                                                                                                                                                                                                                         
C9403001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC AGENT, I-131 SODIUM IODIDE CAPSULE,    Dx I131 so iodide cap, brand53      A                                          621 of MMA                        A9528                    D                          D1E 4      0200401012006010120051231D                           
C9403002004BRAND NAME,  PER MILLICURIE                                                                                                                                                                                                                                                                                          
C9404001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC AGENT, I-131 SODIUM IODIDE SOLUTION,   Dx I131 so iodide sol, brand53      A                                          621 of MMA                        A9529                    D                          I1E 4      0200401012006010120051231D                           
C9404002004BRAND NAME, PER MILLICURIE                                                                                                                                                                                                                                                                                           
C9405001003SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC AGENT, I-131 SODIUM IODIDE SOLUTION,  Th I131 so iodide sol, brand53      A                                          621 of MMA                        A9530                    D                          I1E 4      0200401012006010120051231D                           
C9405002004BRAND NAME, PER MILLICURIE                                                                                                                                                                                                                                                                                           
C9410001003INJECTION, DEXRAZOXANE HYDROCHLORIDE, BRAND NAME, PER 250 MG                    Dexrazoxane HCl inj, brand  53      A                                          621 of MMA                        J1190                    D                          O1E 1P     0200401012006010120051231D                           
C9411001003INJECTION, PAMIDRONATE DISODIUM, BRAND NAME, PER 30 MG                          Pamidronate disodium, brand 53      A                                          621 of MMA                        J2430                    D                          O1E 1P     0200401012006010120051231D                           
C9412001003GANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT, BRAND NAME                            Ganciclovir implant, brand  53      A                                          621 of MMA                        J7310                    D                          O1E 9      0200401012005010120041231N                           
C9413001003SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR INJECTION, BRAND   Sodium hyaluronate inj, bran53      A                                          621 of MMA                        J7317                    D                          O1E 1      0200401012006010120051231D                           
C9413002004NAME                                                                                                                                                                                                                                                                                                                 
C9414001003ETOPOSIDE, ORAL, BRAND NAME, 50 MG                                              Etoposide oral, brand       53      A                                          621 of MMA                        J8560                    D                          O1D 1      0200401012006010120051231D                           
C9415001003DOXORUBICIN HCL, BRAND NAME, 10 MG                                              Doxorubic hcl chemo, brand  53      A                                          621 of MMA                        J9000                    D                          O1D 1      0200401012006010120051231D                           
C9417001003BLEOMYCIN SULFATE, BRAND NAME, 15 UNITS                                         Bleomycin sulfate inj, brand53      A                                          621 of MMA                        J9040                    D                          O1D 1      0200401012006010120051231D                           
C9418001003CISPLATIN, POWDER OR S0LUTION, BRAND NAME, PER 10 MG                            Cisplatin inj, brand        53      A                                          621 of MMA                        J9060                    D                          O1D 1      0200401012006010120051231D                           
C9419001003INJECTION, CLADRIBINE, BRAND NAME, PER 1 MG                                     Inj cladribine, brand       53      A                                          621 of MMA                        J9065                    D                          O1D 1      0200401012006010120051231D                           
C9420001003CYCLOPHOSPHAMIDE, BRAND NAME, 100 MG                                            Cyclophosphamide inj, brand 53      A                                          621 of MMA                        J9070                    D                          O1D 1      0200401012006010120051231D                           
C9421001003CYCLOPHOSPHAMIDE, LYOPHILIZED, BRAND NAME, 100 MG                               Cyclophosphamide lyo, brand 53      A                                          621 of MMA                        J9093                    D                          O1D 1      0200401012006010120051231D                           
C9422001003CYTARABINE, BRAND NAME, 100 MG                                                  Cytarabine hcl inj, brand   53      A                                          621 of MMA                        J9100                    D                          O1D 1      0200401012006010120051231D                           
C9423001003DACARBAZINE, BRAND NAME, 100 MG                                                 Dacarbazine inj, brand      53      A                                          621 of MMA                        J9130                    D                          O1D 1      0200401012006010120051231D                           
C9424001003DAUNORUBICIN, BRAND NAME, 10 MG                                                 Daunorubicin, brand         53      A                                          621 of MMA                        J9150                    D                          O1D 1      0200401012006010120051231D                           
C9425001003ETOPOSIDE, BRAND NAME, 10 MG                                                    Etoposide inj, brand        53      A                                          621 of MMA                        J9181                    D                          O1D 1      0200401012006010120051231D                           
C9426001003FLOXURIDINE, BRAND NAME, 500 MG                                                 Floxuridine inj, brand      53      A                                          621 of MMA                        J9200                    D                          O1D 1      0200401012006010120051231D                           
C9427001003IFOSFAMIDE, BRAND NAME, 1 GM                                                    Ifosfamide inj, brand       53      A                                          621 of MMA                        J9208                    D                          O1D 1      0200401012006010120051231D                           
C9428001003MESNA, BRAND NAME, 200 MG                                                       Mesna injection, brand      53      A                                          621 of MMA                        J9209                    D                          O1D 1      0200401012006010120051231D                           
C9429001003IDARUBICIN HYDROCHLORIDE, BRAND NAME, 5 MG                                      Idarubicin hcl inj, brand   53      A                                          621 of MMA                        J9211                    D                          O1D 1      0200401012006010120051231D                           
C9430001003LEUPROLIDE ACETATE, BRAND NAME, PER 1 MG                                        Leuprolide acetate inj, bran53      A                                          621 of MMA                        J9218                    D                          O1D 1      0200401012006010120051231D                           
C9431001003PACLITAXEL, BRAND NAME, 30 MG                                                   Paclitaxel inj, brand       53      A                                          621 of MMA                        J9265                    D                          O1D 1      0200401012006010120051231D                           
C9432001003MITOMYCIN, BRAND NAME, 5 MG                                                     Mitomycin inj, brand        53      A                                          621 of MMA                        J9280                    D                          O1D 1      0200401012006010120051231D                           
C9433001003THIOTEPA, BRAND NAME, 15 MG                                                     Thiotepa inj, brand         53      A                                          621 of MMA                        J9340                    D                          O1D 1      0200401012006010120051231D                           
C9435001003INJECTION, GONADORELIN HYDROCHLORIDE, BRAND NAME, PER 100 MCG                   Gonadorelin hydroch, brand  53      A                                          1833(t)                           J1620                    D                          O1E 9      0200501012006010120051231D                           
C9436001003AZATHIOPRINE, PARENTERAL, BRAND NAME, PER 100 MG                                Azathioprine parenteral,brnd53      A                                          1833(t)                           J7501                    D                          O1E 9      0200501012006010120051231D                           
C9437001003CARMUSTINE, BRAND NAME, 100 MG                                                  Carmus bischl nitro inj     53      A                                          1833(t)                           J9050                    D                          O1D 9      0200501012006010120051231D                           
C9438001003CYCLOSPORINE, ORAL, BRAND NAME, 100 MG                                          Cyclosporine oral, brand    53      A                                          621 of MMA                        J7502                    D                          O1E 1G     0200401012006010120051231D                           
C9439001003DIETHYLSTILBESTROL DIPHOSPHATE, BRAND NAME, 250 MG                              Diethylstilbestrol injection53      A                                          1833(t)                           J9165                    D                          O1D 9      0200501012006010120051231D                           
C9440001003VINORELBINE TARTRATE, BRAND NAME, PER 10 MG                                     Vinorelbine tar,brand       53      A                                          1833(T)                           J9390                    D                          O1D 9      0200501012006010120051231D                           
C9503001003FRESH FROZEN PLASMA, DONOR RETESTED, EACH UNIT                                  Fresh frozen plasma, ea unit53      A                                          1833(t)                                                    D                      0093T1H 9      0200010012004010120031231N                           
C9701001003STRETTA SYSTEM                                                                  Stretta System              53      A                                          1833(T)                                                    D                      0093P8B 9S     0200101012005010120041231N                           
C9703001003BARD ENDOSCOPIC SUTURING SYSTEM                                                 Bard Endoscopic Suturing Sys53      A                                          1833(T)                                                    D                          P8B 9      0200201012005010120041231N                           
C9704001003INJECTION OR INSERTION OF INERT SUBSTANCE FOR SUBMUCOSAL/INTRAMUSCULAR          Inj inert subs upper GI     53      A                                          1833T                             0133T                    D                          P5E 2      0200401012006010120051231D                           
C9704002004INJECTION(S) INTO THE UPPER GASTROINTESTINAL TRACT, UNDER FLUOROSCOPIC GUIDANCE                                                                                                                                                                                                                                      
C9708001003PREVIEW TREATMENT PLANNING SOFTWARE                                             Preview Tx Planning Software53      A                                          1833(T)                                                    D                          I2B 4      0200107012003010120021231N                           
C9711001003H.E.L.P. APHERESIS SYSTEM                                                       H.E.L.P. Apheresis System   53      A                                          1833(T)                                                    D                          D1A 9      0200110012004010120031231N                           
C9712001003INSERTION OF A PH CAPSULE FOR MEASUREMENT AND MONITORING OF GASTROESOPHAGEAL    Insert pH capsule, GERD     53      A                                          1833(T)                           91035                    D                          T2D 1      0200404012005010120041231N                           
C9712002004REFLUX DISEASE, INCLUDES DATA COLLECTION AND INTERPRETATION                                                                                                                                                                                                                                                          
C9713001003NON-CONTACT LASER VAPORIZATION OF PROSTATE, INCLUDING COAGULATION CONTROL OF    Non-contact laser vap prosta53      A                                          1833(T)                           52648                    D                          P1D 2      0200404012006010120051231D                           
C9713002004INTRAOPERATIVE AND POST-OPERATIVE BLEEDING                                                                                                                                                                                                                                                                           
C9714001003PLACEMENT OF BALLOON CATHETER INTO THE BREAST FOR INTERSTITIAL RADIATION        Breast inters rad tx, immed 53      A                                          1833(T)                           19297                    D                          P7A 6      0200404012005010120041231N                           
C9714002004THERAPY FOLLOWING A PARTIAL MASTECTOMY; CONCURRENT/IMMEDIATE (ADD-ON)                                                                                                                                                                                                                                                
C9715001003PLACEMENT OF BALLOON CATHETER INTO THE BREAST FOR INTERSTITIAL RADIATION        Breast inters rad tx, delay 53      A                                          1833(T)                           19296                    D                          P7A 6      0200404012005010120041231N                           
C9715002004THERAPY FOLLOWING A PARTIAL MASTECTOMY; DELAYED                                                                                                                                                                                                                                                                      
C9716001003CREATIONS OF THERMAL ANAL LESIONS BY RADIOFREQUENCY ENERGY                      Radiofrequency energy to anu53      A                                          1833T                                                      D                          P6D 2      02004070120040701        N                           
C9717001003HEMORRHOIDOPEXY, COMPLEX OR EXTENSIVE, BY A CIRCULAR STAPLER                    Stapled hemorrhoidopexy     53      A                                          1833T                             46947                    D                          P5E 2      0200410012005010120041231N                           
C9718001003KYPHOPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION              Kyphoplasty, first vertebra 53      A                                          1833(t)                           22523                    D                          P5B 1      0200501012006010120051231D                           
C9719001003KYPHOPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; EACH        Kyphoplasty, each addl      53      A                                          1833(t)                           22525                    D                          P5B 1      0200501012006010120051231D                           
C9719002004ADDITIONAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY                                                                                                                                                                                                                                           
C9719003004PROCEDURE)                                                                                                                                                                                                                                                                                                           
C9720001003HIGH-ENERGY (GREATER THAN 0.22MJ/MM2) EXTRACORPOREAL SHOCK WAVE (ESW) TREATMENT HE ESW tx, tennis elbow     53      A                                          1833(t)                           0102T                    D                          P5B 1      0200501012006010120051231D                           
C9720002004FOR CHRONIC LATERAL EPICONDYLITIS (TENNIS ELBOW)                                                                                                                                                                                                                                                                     
C9721001003HIGH-ENERGY (GREATER THAN 0.22MJ/MM2) EXTRACORPOREAL SHOCK WAVE (ESW) TREATMENT HE ESW tx, plantar fasciitis53      A                                          1833(t)                           28890                    D                          P5B 1      0200501012006010120051231D                           
C9721002004FOR CHRONIC PLANTAR FASCIITIS                                                                                                                                                                                                                                                                                        
C9722001003STEREOSCOPIC KV X-RAY IMAGING WITH INFRARED TRACKING FOR LOCALIZATION OF TARGET KV imaging w/IR tracking    53      A                                          1833(t)                           77421                    D                          I4B 4      0200501012006010120051231D                           
C9722002004VOLUME (DO NOT REPORT C9722 IN CONJUNCTION WITH G0173, G0243, G0251, G0339 OR                                                                                                                                                                                                                                        
C9722003004G0340)                                                                                                                                                                                                                                                                                                               
C9723001003DYNAMIC INFRARED BLOOD PERFUSION IMAGING (DIRI)                                 Dyn IR Perf Img             53      A                                          1833(T)                                                    D                      0093I4B 4      02005040120050401        A                           
C9724001003ENDOSCOPIC FULL-THICKNESS PLICATION IN THE GASTRIC CARDIA USING ENDOSCOPIC      EPS gast cardia plic        53      A                                          1833(T)                                                    D                          P8I 2      02005040120050401        A                           
C9724002004PLICATION SYSTEM (EPS); INCLUDES ENDOSCOPY                                                                                                                                                                                                                                                                           
C9725001003PLACEMENT OF ENDORECTAL INTRACAVITARY APPLICATOR FOR HIGH INTENSITY             Place endorectal app        53      A                                          1833(T)                                                    D                          P7A 6      02005100120051001        A                           
C9725002004BRACHYTHERAPY                                                                                                                                                                                                                                                                                                        
D0120001003PERIODIC ORAL EVALUATION                                                        Periodic oral evaluation    00      9                                          1862A(12)                                                  S                      0059Y1  1      01982010119970101        N                           
D0140001003LIMITED ORAL EVALUATION - PROBLEM FOCUSED                                       Limit oral eval problm focus00      9                                          1862A(12)                                                  S                          Y1  1      01996010119960101        N                           
D0150001003COMPREHENSIVE ORAL EVALUATION - NEW OR ESTABLISHED PATIENT                      Comprehensve oral evaluation13      A50-26             2136    2336                                                                       D                          Y1  1      01996010120030101        N                           
D0160001003DETAILED AND EXTENSIVE ORAL EVALUATION - PROBLEM FOCUSED, BY REPORT             Extensv oral eval prob focus00      9                                          1862A(12)                                                  S                          Y1  1      01996010119960101        N                           
D0170001003RE-EVALUATION-LIMITED, PROBLEM FOCUSED (ESTABLISHED PATIENT; NOT POST-OPERATIVE Re-eval,est pt,problem focus00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D0170002004VISIT)                                                                                                                                                                                                                                                                                                               
D0180001003COMPREHENSIVE PERIODONTAL EVALUATION - NEW OR ESTABLISHED PATIENT               Comp periodontal evaluation 00      9                                          1862a(12)                                                  S                          Y1  1      02003010120030101        N                           
D0210001003INTRAORAL-COMPLETE SERIES (INCLUDING BITEWINGS)                                 Intraor complete film series00      9                                                                            70320                    I                          Y1  4      01982010119960101        N                           
D0220001003INTRAORAL-PERIAPICAL-FIRST FILM                                                 Intraoral periapical first f00      9                                                                            70300                    I                          Y1  4      01984010119960101        N                           
D0230001003INTRAORAL-PERIAPICAL-EACH ADDITIONAL FILM                                       Intraoral periapical ea add 00      9                                                                            70310                    I                          Y1  4      01984010119960101        N                           
D0240001003INTRAORAL-0CCLUSAL FILM                                                         Intraoral occlusal film     13      A                  2136    2336                                                                       D                          Y1  4      01984010119930101        N                           
D0250001003EXTRAORAL-FIRST FILM                                                            Extraoral first film        13      A                  2136    2336                                                                       D                          Y1  4      01984010119930101        N                           
D0260001003EXTRAORAL-EACH ADDITIONAL FILM                                                  Extraoral ea additional film13      A                  2136    2336                                                                       D                          Y1  4      01982010119930101        N                           
D0270001003BITEWING-SINGLE FILM                                                            Dental bitewing single film 13      A                  2136    2336                                                                       D                          Y1  4      01982010119930101        N                           
D0272001003BITEWINGS-TWO FILMS                                                             Dental bitewings two films  13      A                  2136    2336                                                                       D                          Y1  4      01982010119930101        N                           
D0274001003BITEWINGS-FOUR FILMS                                                            Dental bitewings four films 13      A                  2136    2336                                                                       D                          Y1  4      01982010119930101        N                           
D0277001003VERTICAL BITEWINGS - 7 TO 8 FILMS                                               Vert bitewings-sev to eight 13      A                  2136    2336                                                                       D                          Y1  4      02000010120000101        N                           
D0290001003POSTERIOR-ANTERIOR OR LATERAL SKULL AND FACIAL BONE SURVEY FILM                 Dental film skull/facial bon00      9                                                                            70150                    I                          Y1  4      01982010119960101        N                           
D0310001003SIALOGRAPHY                                                                     Dental saliography          00      9                                                                            70390                    I                          Y1  4      01986010119960101        N                           
D0320001003TEMPOROMANDIBULAR JOINT ARTHROGRAM, INCLUDING INJECTION                         Dental tmj arthrogram incl i00      9                                                                            70332                    I                          Y1  4      01986010119960101        N                           
D0321001003OTHER TEMPOROMANDIBULAR JOINT FILMS, BY REPORT                                  Dental other tmj films      00      9                                                                            76499                    I                          Y1  4      01984010119960101        N                           
D0322001003TOMOGRAPHIC SURVEY                                                              Dental tomographic survey   00      950-26                                                                       CPT                      I                          Y1  4      01992010119960101        N                           
D0330001003PANORAMIC FILM                                                                  Dental panoramic film       00      9                                                                            70320                    I                          Y1  4      01984010119960101        N                           
D0340001003CEPHALOMETRIC FILM                                                              Dental cephalometric film   00      9                                                                            70350                    I                          Y1  4      01982010119960101        N                           
D0350001003ORAL/FACIAL PHOTOGRAPHIC IMAGES                                                 Oral/facial photo images    00      9                                                                                                     I                      0090Y1  4      02000010120050101        N                           
D0415001003COLLECTION OF MICROORGANISMS FOR CULTURE AND SENSITIVITY                        Collection of microorganisms00      9                                          1862 A(12)                        D0410                    S                      0059Y1  5      01992010120050101        N                           
D0416001003VIRAL CULTURE                                                                   Viral culture               00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0421001003GENETIC TEST FOR SUSCEPTIBILITY TO ORAL DISEASES                                Gen tst suscept oral disease00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0425001003CARIES SUSCEPTIBILITY TESTS                                                     Caries susceptibility test  00      9                                          1862 A(12)                        D0420                    S                      0059Y1  5      01992010119970101        N                           
D0431001003ADJUNCTIVE PRE-DIAGNOSTIC TEST THAT AIDS IN DETECTION OF MUCOSAL ABNORMALITIES  Diag tst detect mucos abnorm00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0431002004INCLUDING PREMALIGNANT AND MALIGNANT LESIONS, NOT TO INCLUDE CYTOLOGY OR BIOPSY                                                                                                                                                                                                                                      
D0431003004PROCEDURES                                                                                                                                                                                                                                                                                                           
D0460001003PULP VITALITY TESTS                                                             Pulp vitality test          13      A50-26             2136    2336                                                                       D                          Y1  5      01982010119930101        N                           
D0470001003DIAGNOSTIC CASTS                                                                Diagnostic casts            00      9                                          1862 a(12)                                                 S                          Y1  5      01982010119960101        N                           
D0472001003ACCESSION OF TISSUE, GROSS EXAMINATION, PREPARATION AND TRANSMISSION OF WRITTEN Gross exam, prep & report   13      A50-26             2136    2336                                                                       D                          Y1  5      02000010120000101        N                           
D0472002004REPORT                                                                                                                                                                                                                                                                                                               
D0473001003ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, PREPARATION AND         Micro exam, prep & report   13      A50-26             2136    2336                                                                       D                          Y1  5      02000010120000101        N                           
D0473002004TRANSMISSION OF WRITTEN REPORT                                                                                                                                                                                                                                                                                       
D0474001003ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINATION, INCLUDING ASSESSMENT OF Micro w exam of surg margins13      A50-26             2136    2336                                                                       D                          Y1  5      02000010120000101        N                           
D0474002004SURGICAL MARGINS FOR PRESENCE OF DISEASE, PREPARATION AND TRANSMISSION OF                                                                                                                                                                                                                                            
D0474003004WRITTEN REPORT                                                                                                                                                                                                                                                                                                       
D0475001003DECALCIFICATION PROCEDURE                                                       Decalcification procedure   00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0476001003SPECIAL STAINS FOR MICROORGANISMS                                               Spec stains for microorganis00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0477001003SPECIAL STAINS, NOT FOR MICROORGANISMS                                          Spec stains not for microorg00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0478001003IMMUNOHISTOCHEMICAL STAINS                                                      Immunohistochemical stains  00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0479001003TISSUE IN-SITU HYBRIDIZATION, INCLUDING INTERPRETATION                          Tissue in-situ hybridization00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0480001003PROCESSING AND INTERPRETATION OF EXFOLIATIVE CYTOLOGIC SMEARS, INCLUDING THE    Cytopath smear prep & report13      A50-26             2136    2336                                                                       D                          Y1  5      02000010120050101        N                           
D0480002004PREPARATION AND TRANSMISSION OF WRITTEN REPORT                                                                                                                                                                                                                                                                       
D0481001003ELECTRON MICROSCOPY - DIAGNOSTIC                                                Electron microscopy diagnost00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0482001003DIRECT IMMUNOFLUORESCENCE                                                       Direct immunofluorescence   00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0483001003INDIRECT IMMUNOFLUORESCENCE                                                     Indirect immunofluorescence 00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0484001003CONSULTATION ON SLIDES PREPARED ELSEWHERE                                       Consult slides prep elsewher00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0485001003CONSULTATION, INCLUDING PREPARATION OF SLIDES FROM BIOPSY MATERIAL SUPPLIED BY  Consult inc prep of slides  00      9                                                                                                     C                          Y1  5      02005010120050101        N                           
D0485002004REFERRING SOURCE                                                                                                                                                                                                                                                                                                     
D0501001003HISTOPATHOLOGIC EXAMINATIONS                                                    Histopathologic examinations13      A50-26             2136    2336                                                                       D                          Y1  5      0198601012003010120021231N                           
D0502001003OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT                                      Other oral pathology procedu13      A50-26             2136    2336                                                                       D                          Y1  5      01986010119930101        N                           
D0999001003UNSPECIFIED DIAGNOSTIC PROCEDURE, BY REPORT                                     Unspecified diagnostic proce13      A50-26             2136    2336                                                                       D                          Y1  5      01984010119930101        N                           
D1110001003PROPHYLAXIS-ADULT                                                               Dental prophylaxis adult    00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D1120001003PROPHYLAXIS-CHILD                                                               Dental prophylaxis child    00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D1201001003TOPICAL APPLICATION OF FLUORIDE (INCLUDING PROPHYLAXIS)-CHILD                   Topical fluor w prophy child00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D1203001003TOPICAL APPLICATION OF FLUORIDE (PROPHYLAXIS NOT INCLUDED)-CHILD                Topical fluor w/o prophy chi00      9                                          1862 a(12)                                                 S                          Y1  1      01986010119960101        N                           
D1204001003TOPICAL APPLICATION OF FLUORIDE (PROPHYLAXIS NOT INCLUDED)-ADULT                Topical fluor w/o prophy adu00      9                                          1862 a(12)                                                 S                          Y1  1      01986010119960101        N                           
D1205001003TOPICAL APPLICATION OF FLUORIDE (INCLUDING PROPHYLAXIS)-ADULT                   Topical fluoride w/ prophy a00      9                                          1862 a(12)                        D1202                    S                          Y1  1      01992010119960101        N                           
D1310001003NUTRITIONAL COUNSELING FOR THE CONTROL OF DENTAL DISEASE                        Nutri counsel-control caries00      9                  2300                                                                               M                          Y1  1      01982010119960101        N                           
D1320001003TOBACCO COUNSELING FOR THE CONTROL AND PREVENTION OF ORAL DISEASE               Tobacco counseling          00      9                  2300                                                                               M                          Y1  1      01996010119960101        N                           
D1330001003ORAL HYGIENE INSTRUCTION                                                        Oral hygiene instruction    00      9                  2300                                                                               M                          Y1  1      01982010119960101        N                           
D1351001003SEALANT-PER TOOTH                                                               Dental sealant per tooth    00      9                                          1862 a(12)                                                 S                          Y1  1      01985010119960101        N                           
D1510001003SPACE MAINTAINER-FIXED UNILATERAL                                               Space maintainer fxd unilat 13      A                  2336                                                                               D                          Y1  9      01984010119930101        N                           
D1515001003SPACE MAINTAINER-FIXED BILATERAL                                                Fixed bilat space maintainer13      A                  2336    2136                                                                       D                          Y1  9      01984010119930101        N                           
D1520001003SPACE MAINTAINER-REMOVABLE UNILATERAL                                           Remove unilat space maintain13      A                  2336    2136                                                                       D                          Y1  9      01984010119930101        N                           
D1525001003SPACE MAINTAINER-REMOVABLE BILATERAL                                            Remove bilat space maintain 13      A                  2336    2136                                                                       D                          Y1  9      01984010119930101        N                           
D1550001003RECEMENTATION OF SPACE MAINTAINER                                               Recement space maintainer   13      A                  2336    2136                                                                       D                          Y1  1      01982010119930101        N                           
D2110001003AMALGAM-ONE SURFACE, PRIMARY                                                    Amalgam one surface primary 00      9                                          1862 a(12)                                                 S                          Y1  1      0198501012003010120021231N                           
D2120001003AMALGAM-TWO SURFACES, PRIMARY                                                   Amalgam two surfaces primary00      9                                          1862 a(12)                                                 S                          Y1  1      0198501012003010120021231N                           
D2130001003AMALGAM-THREE SURFACES, PRIMARY                                                 Amalgam three surfaces prima00      9                                          1862 a(12)                                                 S                          Y1  1      0198501012003010120021231N                           
D2131001003AMALGAM-FOUR OR MORE SURFACES, PRIMARY                                          Amalgam four/more surf prima00      9                                          1862 a(12)                                                 S                          Y1  1      0198501012003010120021231N                           
D2140001003AMALGAM-ONE SURFACE, PRIMARY OR PERMANENT                                       Amalgam one surface permanen00      9                                          1862 a(12)                                                 S                          Y1  1      01982010120030101        N                           
D2150001003AMALGAM-TWO SURFACES, PRIMARY OR PERMANENT                                      Amalgam two surfaces permane00      9                                          1862 a(12)                                                 S                          Y1  1      01982010120030101        N                           
D2160001003AMALGAM-THREE SURFACES, PRIMARY OR PERMANENT                                    Amalgam three surfaces perma00      9                                          1862 a(12)                                                 S                          Y1  1      01982010120030101        N                           
D2161001003AMALGAM-FOUR OR MORE SURFACES, PRIMARY OR PERMANENT                             Amalgam 4 or > surfaces perm00      9                                          1862 a(12)                                                 S                          Y1  1      01982010120030101        N                           
D2330001003RESIN-ONE SURFACE, ANTERIOR                                                     Resin one surface-anterior  00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D2331001003RESIN-TWO SURFACES, ANTERIOR                                                    Resin two surfaces-anterior 00      9                                          1861 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D2332001003RESIN-THREE SURFACES, ANTERIOR                                                  Resin three surfaces-anterio00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D2335001003RESIN-FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR)               Resin 4/> surf or w incis an00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D2336001003COMPOSITE RESIN CROWN-ANTERIOR-PRIMARY                                          Composite resin crown       00      9                                          1862 a(12)                                                 S                          Y1  1      0199201012003010120021231N                           
D2337001003RESIN-BASED COMPOSITE CROWN, ANTERIOR-PERMANENT                                 Compo resin crown ant-perm  00      9                                          1862a(12)                                                  S                          Y1  1      0200001012003010120021231N                           
D2380001003RESIN-ONE SURFACE, POSTERIOR-PRIMARY                                            Resin one surf poster primar00      9                                          1862 a(12)                                                 S                          Y1  1      0199201012003010120021231N                           
D2381001003RESIN-TWO SURFACES, POSTERIOR-PRIMARY                                           Resin two surf poster primar00      9                                          1862 a(12)                                                 S                          Y1  1      0199201012003010120021231N                           
D2382001003RESIN-THREE OR MORE SURFACES, POSTERIOR-PRIMARY                                 Resin three/more surf post p00      9                                          1862 a(12)                                                 S                          Y1  1      0199201012003010120021231N                           
D2385001003RESIN-ONE SURFACE, POSTERIOR-PERMANENT                                          Resin one surf poster perman00      9                                          1862 a(12)                                                 S                      0060Y1  1      0199201012003010120021231N                           
D2386001003RESIN-TWO SURFACES, POSTERIOR-PERMANENT                                         Resin two surf poster perman00      9                                          1862 a(12)                                                 S                          Y1  1      0199201012003010120021231N                           
D2387001003RESIN-THREE OR MORE SURFACES, POSTERIOR-PERMANENT                               Resin three/more surf post p00      9                                          1862 a(12)                                                 S                          Y1  1      0199201012003010120021231N                           
D2388001003RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR PERMANENT              Resin four/more, post perm  00      9                                          1862a(12)                                                  S                          Y1  1      0200001012003010120021231N                           
D2390001003RESIN-BASED COMPOSITE CROWN, ANTERIOR                                           Ant resin-based cmpst crown 00      9                                          1862a(12)                                                  S                          Y1  1      02003010120030101        N                           
D2391001003RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR                                  Post 1 srfc resinbased cmpst00      9                                          1862a(12)                                                  S                          Y1  1      02003010120030101        N                           
D2392001003RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR                                 Post 2 srfc resinbased cmpst00      9                                          1862a(12)                                                  S                          Y1  1      02003010120030101        N                           
D2393001003RESIN-BASED COMPOSITE - THREE SURFACES, POSTERIOR                               Post 3 srfc resinbased cmpst00      9                                          1862a(12)                                                  S                          Y1  1      02003010120030101        N                           
D2394001003RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, POSTERIOR                        Post >=4srfc resinbase cmpst00      9                                          1862a(12)                                                  S                          Y1  1      02003010120030101        N                           
D2410001003GOLD FOIL-ONE SURFACE                                                           Dental gold foil one surface00      9                                          1862 a(12)                                                 S                          Y1  1      01982010119960101        N                           
D2420001003GOLD FOIL-TWO SURFACES                                                          Dental gold foil two surface00      9                                          1862 a(12)                                                 S                          Y1  1      01982010119960101        N                           
D2430001003GOLD FOIL-THREE SURFACES                                                        Dental gold foil three surfa00      9                                          1862 a(12)                                                 S                          Y1  1      01982010119960101        N                           
D2510001003INLAY-METALLIC-ONE SURFACE                                                      Dental inlay metalic 1 surf 00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D2520001003INLAY-METALLIC-TWO SURFACES                                                     Dental inlay metallic 2 surf00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D2530001003INLAY-METALLIC-THREE OR MORE SURFACES                                           Dental inlay metl 3/more sur00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D2542001003ONLAY-METALLIC-TWO SURFACES                                                     Dental onlay metallic 2 surf00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D2543001003ONLAY - METALLIC - THREE SURFACES                                               Dental onlay metallic 3 surf00      9                                          1862 a(12)                                                 S                          Y1  1      01996010119960101        N                           
D2544001003ONLAY - METALLIC - FOUR OR MORE SURFACES                                        Dental onlay metl 4/more sur00      9                                          1862 a(12)                                                 S                          Y1  1      01996010119960101        N                           
D2610001003INLAY-PORCELAIN/CERAMIC-ONE SURFACE                                             Inlay porcelain/ceramic 1 su00      9                                          1862 a(12)                                                 S                          Y1  1      01984010119960101        N                           
D2620001003INLAY-PORCELAIN/CERAMIC-TWO SURFACES                                            Inlay porcelain/ceramic 2 su00      9                                          1862 a(12)                                                 S                          Y1  1      01986010119960101        N                           
D2630001003INLAY-PORCELAIN/CERAMIC-THREE OR MORE SURFACES                                  Dental onlay porc 3/more sur00      9                                          1862 a(12)                                                 S                          Y1  1      01986010119960101        N                           
D2642001003ONLAY - PORCELAIN/CERAMIC - TWO SURFACES                                        Dental onlay porcelin 2 surf00      9                                          1862 a(12)                                                 S                          Y1  1      01996010119960101        N                           
D2643001003ONLAY - PORCELAIN/CERAMIC - THREE SURFACES                                      Dental onlay porcelin 3 surf00      9                                          1862 a(12)                                                 S                          Y1  1      01996010119960101        N                           
D2644001003ONLAY - PORCELAIN/CERAMIC - FOUR OR MORE SURFACES                               Dental onlay porc 4/more sur00      9                                          1862 a(12)                                                 S                          Y1  1      01996010119960101        N                           
D2650001003INLAY - RESIN-BASED COMPOSITE - ONE SURFACE                                     Inlay composite/resin one su00      9                                          1862 a(12)                                                 S                          Y1  1      01992010120000101        N                           
D2651001003INLAY - RESIN-BASED COMPOSITE - TWO SURFACES                                    Inlay composite/resin two su00      9                                          1862 a(12)                                                 S                          Y1  1      01992010120000101        N                           
D2652001003INLAY - RESIN-BASED COMPOSITE - THREE OR MORE SURFACES                          Dental inlay resin 3/mre sur00      9                                          1862 a(12)                                                 S                          Y1  1      01992010120000101        N                           
D2662001003ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES                                    Dental onlay resin 2 surface00      9                                          1862 a(12)                                                 S                          Y1  1      01996010120000101        N                           
D2663001003ONLAY - RESIN-BASED COMPOSITE - THREE SURFACES                                  Dental onlay resin 3 surface00      9                                          1862 a(12)                                                 S                          Y1  1      01996010120000101        N                           
D2664001003ONLAY - - RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES                         Dental onlay resin 4/mre sur00      9                                          1862 a(12)                                                 S                          Y1  1      01996010120000101        N                           
D2710001003CROWN - RESIN-BASED COMPOSITE (INDIRECT)                                        Crown resin-based indirect  00      9                                          1862a(12)                                                  S                          Y1  1      01984010120050101        N                           
D2712001003CROWN - 3/4 RESIN-BASED COMPOSITE (INDIRECT)                                    Crown 3/4 resin-based compos00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D2720001003CROWN-RESIN WITH HIGH NOBLE METAL                                               Crown resin w/ high noble me00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2721001003CROWN-RESIN WITH PREDOMINANTLY BASE METAL                                       Crown resin w/ base metal   00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2722001003CROWN-RESIN WITH NOBLE METAL                                                    Crown resin w/ noble metal  00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2740001003CROWN-PORCELAIN/CERAMIC SUBSTRATE                                               Crown porcelain/ceramic subs00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2750001003CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL                                       Crown porcelain w/ h noble m00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2751001003CROWN-PROCELAIN FUSED TO PREDOMINANTLY BASE METAL                               Crown porcelain fused base m00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D2752001003CROWN-PORCELAIN FUSED TO NOBLE METAL                                            Crown porcelain w/ noble met00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2780001003CROWN - 3/4 CAST HIGH NOBLE METAL                                               Crown 3/4 cast hi noble met 00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D2781001003CROWN - 3/4 CAST PREDOMINANTLY BASE METAL                                       Crown 3/4 cast base metal   00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D2782001003CROWN - 3/4 CAST NOBLE METAL                                                    Crown 3/4 cast noble metal  00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D2783001003CROWN - 3/4 PORCELAIN/CERAMIC                                                   Crown 3/4 porcelain/ceramic 00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D2790001003CROWN-FULL CAST HIGH NOBLE METAL                                                Crown full cast high noble m00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2791001003CROWN-FULL CAST PREDOMINANTLY BASE METAL                                        Crown full cast base metal  00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2792001003CROWN-FULL CAST NOBLE METAL                                                     Crown full cast noble metal 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2794001003CROWN-TITANIUM                                                                  Crown-titanium              00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D2799001003PROVISIONAL CROWN                                                               Provisional crown           00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D2910001003RECEMENT INLAY, ONLAY OR PARTIAL COVERAGE RESTORATION                           Recement inlay onlay or part00      9                                          1862a(12)                                                  S                          Y1  1      01984010120050101        N                           
D2915001003RECEMENT CAST OR PREFABRICATED POST AND CORE                                    Recement cast or prefab post00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D2920001003RECEMENT CROWN                                                                  Dental recement crown       00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2930001003PREFABRICATED STAINLESS STEEL CROWN-PRIMARY TOOTH                               Prefab stnlss steel crwn pri00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D2931001003PREFABRICATED STAINLESS STEEL CROWN-PERMANENT TOOTH                             Prefab stnlss steel crown pe00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D2932001003PREFABRICATED RESIN CROWN                                                       Prefabricated resin crown   00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D2933001003PREFABRICATED STAINLESS STEEL CROWN WITH RESIN WINDOW                           Prefab stainless steel crown00      9                                          1862a(12)                                                  S                          Y1  1      01992010119960101        N                           
D2934001003PREFABRICATED ESTHETIC COATED STAINLESS STEEL CROWN - PRIMARY TOOTH             Prefab steel crown primary  00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D2940001003SEDATIVE FILLING                                                                Dental sedative filling     00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D2950001003CORE BUILD-UP, INCLUDING ANY PINS                                               Core build-up incl any pins 00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D2951001003PIN RETENTION-PER TOOTH, IN ADDITION TO RESTORATION                             Tooth pin retention         00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D2952001003CAST POST AND CORE IN ADDITION TO CROWN                                         Post and core cast + crown  00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D2953001003EACH ADDITIONAL CAST POST  - SAME TOOTH                                         Each addtnl cast post       00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D2954001003PREFABRICATED POST AND CORE IN ADDITION TO CROWN                                Prefab post/core + crown    00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D2955001003POST REMOVAL (NOT IN CONJUCTION WITH ENDODONTIC THERAPY)                        Post removal                00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D2957001003EACH ADDITIONAL PREFABRICATED  POST - SAME TOOTH                                Each addtnl prefab post     00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D2960001003LABIAL VENEER (LAMINATE)-CHAIRSIDE                                              Laminate labial veneer      00      9                                          1862a(12)                                                  S                          Y1  1      01985010119960101        N                           
D2961001003LABIAL VENEER (RESIN LAMINATE)-LABORATORY                                       Lab labial veneer resin     00      9                                          1862a(12)                                                  S                          Y1  1      01992010119960101        N                           
D2962001003LABIAL VENEER (PORCELAIN LAMINATE)-LABORATORY                                   Lab labial veneer porcelain 00      9                                          1862a(12)                                                  S                          Y1  1      01992010119960101        N                           
D2970001003TEMPORARY (FRACTURED TOOTH)                                                     Temporary- fractured tooth  13      A                  2136    2336                                                                       D                          Y1  1      0198601012005010120041231N                           
D2971001003ADDITIONAL PROCEDURES TO CONSTRUCT NEW CROWN UNDER EXISTING PARTIAL DENTURE     Add proc construct new crown00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D2971002004FRAMEWORK                                                                                                                                                                                                                                                                                                            
D2975001003COPING                                                                          Coping                      00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D2980001003CROWN REPAIR, BY REPORT                                                         Crown repair                00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D2999001003UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT                                    Dental unspec restorative pr13      A                  2336    2136                                                                       D                          Y1  1      01986010119930101        N                           
D3110001003PULP CAP-DIRECT (EXCLUDING FINAL RESTORATION)                                   Pulp cap direct             00      9                                          1862a(12)                                                  S                          Y1  1      01982010119960101        N                           
D3120001003PULP CAP-INDIRECT  (EXCLUDING FINAL RESTORATION)                                Pulp cap indirect           00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D3220001003THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION)  REMOVAL OF PULP CORONAL TO Therapeutic pulpotomy       00      9                                          1862a(12)                                                  S                          Y1  2      01984010120000101        N                           
D3220002004THE DENTINOCEMENTAL JUNCTION AND APPLICATION OF MEDICAMENT                                                                                                                                                                                                                                                           
D3221001003PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH                                 Gross pulpal debridement    00      9                                          1862a(12)                                                  S                          Y1  2      02000010120030101        N                           
D3230001003PULPAL THERAPY (RESORBABLE FILLING)-ANTERIOR, PRIMARY TOOTH (EXCLUDING FINAL    Pulpal therapy anterior prim00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D3230002004RESTORATION)                                                                                                                                                                                                                                                                                                         
D3240001003PULPAL THERAPY (RESORBABLE FILLING)-POSTERIOR, PRIMARY TOOTH (EXCLUDING FINAL   Pulpal therapy posterior pri00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D3240002004RESTORATION)                                                                                                                                                                                                                                                                                                         
D3310001003ANTERIOR (EXCLUDING FINAL RESTORATION)                                          Anterior                    00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D3320001003BICUSPID (EXCLUDING FINAL RESTORATION)                                          Root canal therapy 2 canals 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D3330001003MOLAR (EXCLUDING FINAL RESTORATION)                                             Root canal therapy 3 canals 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D3331001003TREATMENT OF ROOT CANAL OBSTRUCTION; NON-SURGICAL ACCESS                        Non-surg tx root canal obs  00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D3332001003INCOMPLETE ENDODONTIC THERAPY; INOPERABLE, UNRESTORABLE OR FRACTURED TOOTH      Incomplete endodontic tx    00      9                                          1862a(12)                                                  S                          Y1  1      02000010120050101        N                           
D3333001003INTERNAL ROOT REPAIR OF PERFORATION DEFECTS                                     Internal root repair        00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D3346001003RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-ANTERIOR                             Retreat root canal anterior 00      9                                          1862a(12)                                                  S                          Y1  1      01992010119960101        N                           
D3347001003RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-BICUSPID                             Retreat root canal bicuspid 00      9                                          1862a(12)                                                  S                          Y1  1      01992010119960101        N                           
D3348001003RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-MOLAR                                Retreat root canal molar    00      9                                          1862a(12)                                                  S                          Y1  1      01992010119960101        N                           
D3351001003APEXIFICATION/RECALCIFICATION-INITIAL VISIT (APICAL CLOSURE/CALCIFIC REPAIR OF  Apexification/recalc initial00      9                                          1862a(12)                                                  S                          Y1  2      01992010119960101        N                           
D3351002004PERFORATIONS, ROOT RESORPTION, ETC.)                                                                                                                                                                                                                                                                                 
D3352001003APEXIFICATION/RECALCIFICATION-INTERIM MEDICATION REPLACEMENT (APICAL            Apexification/recalc interim00      9                                          1862a(12)                                                  S                          Y1  2      01992010119960101        N                           
D3352002004CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)                                                                                                                                                                                                                                                      
D3353001003APEXIFICATION/RECALCIFICATION-FINAL VISIT (INCLUDES COMPLETED ROOT CANAL        Apexification/recalc final  00      9                                          1862a(12)                                                  S                          Y1  2      01992010119960101        N                           
D3353002004THERAPY-APICAL CLOSURE/CALCIFIC REPAIR OF PERFORATIONS, ROOT RESORPTION, ETC.)                                                                                                                                                                                                                                       
D3410001003APICOECTOMY/PERIRADICULAR SURGERY-ANTERIOR                                      Apicoect/perirad surg anter 00      9                                          1862a(12)                                                  S                          Y1  2      01984010119960101        N                           
D3421001003APICOECTOMY/PERIRADICULAR SURGERY-BICUSPID (FIRST ROOT)                         Root surgery bicuspid       00      9                                          1862a(12)                                                  S                          Y1  2      01992010119960101        N                           
D3425001003APICOECTOMY/PERIRADICULAR SURGERY-MOLAR (FIRST ROOT).                           Root surgery molar          00      9                                          1862a(12)                                                  S                          Y1  2      01992010119960101        N                           
D3426001003APICOECTOMY/PERIRADICULAR SURGERY (EACH ADDITIONAL ROOT)                        Root surgery ea add root    00      9                                          1862a(12)                                                  S                          Y1  2      01992010119960101        N                           
D3430001003RETROGRADE FILLING-PER ROOT                                                     Retrograde filling          00      9                                          1862a(12)                                                  S                          Y1  2      01984010119960101        N                           
D3450001003ROOT AMPUTATION-PER ROOT                                                        Root amputation             00      9                                          1862a(12)                                                  S                          Y1  2      01984010119960101        N                           
D3460001003ENDODONTIC ENDOSSEOUS IMPLANT                                                   Endodontic endosseous implan13      A                  2336    2136                                                                       D                          Y1  2      01984010119930101        N                           
D3470001003INTENTIONAL REPLANTATION (INCLUDING NECESSARY SPLINTING)                        Intentional replantation    00      9                                          1862a(12)                                                  S                          Y1  2      01992010119960101        N                           
D3910001003SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM                       Isolation- tooth w rubb dam 00      9                                          1862a(12)                                                  S                          Y1  2      01982010119960101        N                           
D3920001003HEMISECTION (INCLUDING ANY ROOT REMOVAL), NOT INCLUDING ROOT CANAL THERAPY      Tooth splitting             00      9                                          1862a(12)                                                  S                          Y1  2      01984010119960101        N                           
D3950001003CANAL PREPARATION AND FITTING OF PREFORMED DOWEL OR POST                        Canal prep/fitting of dowel 00      9                                          1862a(12)                                                  S                          Y1  1      01982010119960101        N                           
D3999001003UNSPECIFIED ENDODONTIC PROCEDURE, BY REPORT                                     Endodontic procedure        13      A                  2336    2136                                                                       D                          Y1  1      01984010119930101        N                           
D4210001003GINGIVECTOMY OR GINGIVOPLASTY - FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH  Gingivectomy/plasty per quad00      9                                                                            41820                    I                          Y1  2      01985010120050101        N                           
D4210002004SPACES PER QUADRANT                                                                                                                                                                                                                                                                                                  
D4211001003GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE CONTIGUOUS TEETH OR BOUNDED TEETH  Gingivectomy/plasty per toot00      9                                                                            CPT                      I                      0019Y1  2      01986010120050101        N                           
D4211002004SPACES PER QUADRANT                                                                                                                                                                                                                                                                                                  
D4220001003GINGIVAL CURETTAGE, SURGICAL, PER QUADRANT, BY REPORT                           Gingival curettage per quadr00      9                                          1862a(12)                                                  S                          Y1  2      0198401012003010120021231N                           
D4240001003GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - FOUR OR MORE CONTIGUOUS TEETH Gingival flap proc w/ planin00      9                                          1862a(12)                                                  S                          Y1  2      01984010120050101        N                           
D4240002004OR BOUNDED TEETH SPACES PER QUADRANT                                                                                                                                                                                                                                                                                 
D4241001003GINGIVAL FLAP PROCEDURE, INCLUDING ROOT PLANING - ONE TO THREE CONTIGUOUS TEETH Gngvl flap w rootplan 1-3 th00      9                                          1862a(12)                                                  S                          Y1  2      02003010120050101        N                           
D4241002004OR BOUNDED TEETH SPACES PER QUADRANT                                                                                                                                                                                                                                                                                 
D4245001003APICALLY POSITIONED FLAP                                                        Apically positioned flap    00      9                                          1862a(12)                                                  S                          Y1  2      02000010120000101        N                           
D4249001003CLINICAL CROWN LENGTHENING-HARD TISSUE                                          Crown lengthen hard tissue  00      9                                          1862a(12)                                                  S                          Y1  2      01992010119960101        N                           
D4260001003OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - FOUR OR MORE CONTIGUOUS    Osseous surgery per quadrant13      A                  2136    2336                                                                       D                          Y1  2      01985010120050101        N                           
D4260002004TEETH OR BOUNDED TEETH SPACES PER QUADRANT                                                                                                                                                                                                                                                                           
D4261001003OSSEOUS SURGERY (INCLUDING FLAP ENTRY AND CLOSURE) - ONE TO THREE CONTIGUOUS    Osseous surgl-3teethperquad 00      9                                          1862a(12)                                                  S                          Y1  2      02003010120050101        N                           
D4261002004TEETH OR BOUNDED TEETH SPACES PER QUADRANT                                                                                                                                                                                                                                                                           
D4263001003BONE REPLACEMENT GRAFT - FIRST SITE IN QUADRANT                                 Bone replce graft first site13      A50-26             2336    2136                                                                       D                          Y1  2      01996010119960101        N                           
D4264001003BONE REPLACEMENT GRAFT - EACH ADDITIONAL SITE IN QUADRANT                       Bone replce graft each add  13      A50-26             2336    2136                                                                       D                          Y1  2      01996010119960101        N                           
D4265001003BIOLOGIC MATERIALS TO AID IN SOFT AND OSSEOUS TISSUE REGENERATION               Bio mtrls to aid soft/os reg00      9                                          1862a(12)                                                  S                          Y1  2      02003010120030101        N                           
D4266001003GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER SITE                       Guided tiss regen resorble  00      9                                          1862a(12)                                                  S                          Y1  2      01996010120000101        N                           
D4267001003GUIDED TISSUE REGENERATION - NONRESORBABLE BARRIER, PER SITE, (INCLUDES         Guided tiss regen nonresorb 00      9                                          1862a(12)                                                  S                          Y1  2      01996010120000101        N                           
D4267002004MEMBRANE REMOVAL)                                                                                                                                                                                                                                                                                                    
D4268001003SURGICAL REVISION PROCEDURE, PER TOOTH                                          Surgical revision procedure 00      9                  2136    2336                                                                       D                          Y1  2      02000010120000101        N                           
D4270001003PEDICLE SOFT TISSUE GRAFT PROCEDURE                                             Pedicle soft tissue graft pr13      A                  2336    2136                                                                       D                          Y1  2      01984010119930101        N                           
D4271001003FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING DONOR SITE SURGERY)                 Free soft tissue graft proc 13      A                  2336    2136                                                                       D                          Y1  2      01984010119960101        N                           
D4273001003SUBEPITHELIAL CONNECTIVE TISSUE GRAFT PROCEDURES, PER TOOTH                     Subepithelial tissue graft  13      A50-26             2136    2336                                                                       D                          Y1  2      01996010120050101        N                           
D4274001003DISTAL OR PROXIMAL WEDGE PROCEDURE (WHEN NOT PERFORMED IN CONJUCTION WITH       Distal/proximal wedge proc  00      9                                          1862a(12)                                                  S                          Y1  2      01996010119960101        N                           
D4274002004SURGICAL PROCEDURES IN THE SAME ANATOMICAL AREA)                                                                                                                                                                                                                                                                     
D4275001003SOFT TISSUE ALLOGRAFT                                                           Soft tissue allograft       00      9                                          1862a(12)                                                  S                          Y1  2      02003010120030101        N                           
D4276001003COMBINED CONNECTIVE TISSUE AND DOUBLE PEDICLE GRAFT, PER TOOTH                  Con tissue w dble ped graft 00      9                                          1862a(12)                                                  S                          Y1  2      02003010120050101        N                           
D4320001003PROVISIONAL SPLINTING-INTRACORONAL                                              Provision splnt intracoronal00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D4321001003PROVISIONAL SPLINTING-EXTRACORONAL                                              Provisional splint extracoro00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D4341001003PERIODONTAL SCALING AND ROOT PLANING - FOUR OR MORE TEETH PER QUADRANT          Periodontal scaling & root  00      9                                          1862a(12)                                                  S                          Y1  1      01985010120050101        N                           
D4342001003PERIODONTAL SCALING AND ROOT PLANING - ONE TO THREE TEETH, PER QUADRANT         Periodontal scaling 1-3teeth00      9                                          1862a(12)                                                  S                          Y1  1      02003010120030101        N                           
D4355001003FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION AND DIAGNOSIS         Full mouth debridement      13      A50-26             2136    2336                                                                       D                          Y1  1      01996010120030101        N                           
D4381001003LOCALIZED DELIVERY OF ANTIMICROBIAL AGENTS VIA A CONTROLLED RELEASE VEHICLE     Localized delivery antimicro13      A50-26             2136    2336                                                                       D                          Y1  1      01996010120050101        N                           
D4381002004INTO DISEASED CREVICULAR TISSUE, PER TOOTH, BY REPORT                                                                                                                                                                                                                                                                
D4910001003PERIODONTAL MAINTENANCE                                                         Periodontal maint procedures00      9                                          1862a(12)                                                  S                          Y1  1      01984010120030101        N                           
D4920001003UNSCHEDULED DRESSING CHANGE (BY SOMEONE OTHER THAN TREATING DENTIST)            Unscheduled dressing change 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D4999001003UNSPECIFIED PERIODONTAL PROCEDURE, BY REPORT                                    Unspecified periodontal proc00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5110001003COMPLETE DENTURE - MAXILLARY                                                    Dentures complete maxillary 00      9                                          1862a(12)                                                  S                          Y1  9      01982010119960101        N                           
D5120001003COMPLETE DENTURE - MANDIBULAR                                                   Dentures complete mandible  00      9                                          1862a(12)                                                  S                          Y1  9      01982010119960101        N                           
D5130001003IMMEDIATE DENTURE - MAXILLARY                                                   Dentures immediat maxillary 00      9                                          1862a(12)                                                  S                          Y1  9      01982010119960101        N                           
D5140001003IMMEDIATE DENTURE - MANDIBULAR                                                  Dentures immediat mandible  00      9                                          1862a(12)                                                  S                          Y1  9      01982010119960101        N                           
D5211001003UPPER PARTIAL-RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)   Dentures maxill part resin  00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5212001003LOWER PARTIAL-RESIN BASE (INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)   Dentures mand part resin    00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5213001003MAXILLARY PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES       Dentures maxill part metal  00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5213002004(INCLUDING ANY CONVENTIONAL CLASPS, RESTS AND TEETH)                                                                                                                                                                                                                                                                 
D5214001003MANDIBULAR PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES      Dentures mandibl part metal 00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5214002004(INCLUDING ANY CONVENTIONAL CLASPS,RESTS AND TEETH)                                                                                                                                                                                                                                                                  
D5225001003MAXILLARY PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND      Maxillary part denture flex 00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D5225002004TEETH)                                                                                                                                                                                                                                                                                                               
D5226001003MANDIBULAR PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING ANY CLASPS, RESTS AND     Mandibular part denture flex00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D5226002004TEETH)                                                                                                                                                                                                                                                                                                               
D5281001003REMOVABLE UNILATERAL PARTIAL DENTURE-ONE PIECE CAST METAL (INCLUDING CLASPS AND Removable partial denture   00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5281002004TEETH)                                                                                                                                                                                                                                                                                                               
D5410001003ADJUST COMPLETE DENTURE - MAXILLARY                                             Dentures adjust cmplt maxil 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5411001003ADJUST COMPLETE DENTURE - MANDIBULAR                                            Dentures adjust cmplt mand  00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D5421001003ADJUST PARTIAL DENTURE - MAXILLARY                                              Dentures adjust part maxill 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5422001003ADJUST PARTIAL DENTURE - MANDIBULAR                                             Dentures adjust part mandbl 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5510001003REPAIR BROKEN COMPLETE DENTURE BASE                                             Dentur repr broken compl bas00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D5520001003REPLACE MISSING OR BROKEN TEETH-COMPLETE DENTURE (EACH TOOTH)                   Replace denture teeth complt00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D5610001003REPAIR RESIN DENTURE BASE                                                       Dentures repair resin base  00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5620001003REPAIR CAST FRAMEWORK                                                           Rep part denture cast frame 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5630001003REPAIR OR REPLACE BROKEN CLASP                                                  Rep partial denture clasp   00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5640001003REPLACE BROKEN TEETH-PER TOOTH                                                  Replace part denture teeth  00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5650001003ADD TOOTH TO EXISTING PARTIAL DENTURE                                           Add tooth to partial denture00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5660001003ADD CLASP TO EXISTING PARTIAL DENTURE                                           Add clasp to partial denture00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5670001003REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MAXILLARY)               Replc tth&acrlc on mtl frmwk00      9                                          1862a(12)                                                  S                          Y1  1      02003010120030101        N                           
D5671001003REPLACE ALL TEETH AND ACRYLIC ON CAST METAL FRAMEWORK (MANDIBULAR)              Replc tth&acrlc mandibular  00      9                                          1862a(12)                                                  S                          Y1  1      02003010120030101        N                           
D5710001003REBASE COMPLETE MAXILLARY DENTURE                                               Dentures rebase cmplt maxil 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5711001003REBASE COMPLETE MANDIBULAR DENTURE                                              Dentures rebase cmplt mand  00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D5720001003REBASE MAXILLARY PARTIAL DENTURE                                                Dentures rebase part maxill 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5721001003REBASE MANDIBULAR PARTIAL DENTURE                                               Dentures rebase part mandbl 00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D5730001003RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)                                   Denture reln cmplt maxil ch 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5731001003RELINE LOWER COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)                            Denture reln cmplt mand chr 00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D5740001003RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)                                    Denture reln part maxil chr 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5741001003RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)                                   Denture reln part mand chr  00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D5750001003RELINE COMPLETE MAXILLARY DENTURE (LABORATORY)                                  Denture reln cmplt max lab  00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5751001003RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY)                                 Denture reln cmplt mand lab 00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D5760001003RELINE MAXILLARY PARTIAL DENTURE (LABORATORY)                                   Denture reln part maxil lab 00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D5761001003RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY)                                  Denture reln part mand lab  00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D5810001003INTERIM COMPLETE DENTURE (MAXILLARY)                                            Denture interm cmplt maxill 00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5811001003INTERIM COMPLETE DENTURE (MANDIBULAR)                                           Denture interm cmplt mandbl 00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5820001003INTERIM PARTIAL DENTURE (MAXILLARY)                                             Denture interm part maxill  00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5821001003INTERIM PARTIAL DENTURE (MANDIBULAR)                                            Denture interm part mandbl  00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5850001003TISSUE CONDITIONING, MAXILLARY                                                  Denture tiss conditn maxill 00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5851001003TISSUE CONDITIONING, MANDIBULAR                                                 Denture tiss condtin mandbl 00      9                                          1862a(12)                                                  S                          Y1  9      01992010119960101        N                           
D5860001003OVERDENTURE-COMPLETE, BY REPORT                                                 Overdenture complete        00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5861001003OVERDENTURE-PARTIAL, BY REPORT                                                  Overdenture partial         00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D5862001003PRECISION ATTACHMENT, BY REPORT                                                 Precision attachment        00      9                                          1862a(12)                                                  S                          Y1  9      01986010119960101        N                           
D5867001003REPLACEMENT OF REPLACEABLE PART OF SEMI-PRECISION OR PRECISION ATTACHMENT (MALE Replacement of precision att00      9                                          1862a(12)                                                  S                          Y1  9      02000010120000101        N                           
D5867002004OR FEMALE COMPONENT)                                                                                                                                                                                                                                                                                                 
D5875001003MODIFICATION OF REMOVABLE PROSTHESIS FOLLOWING IMPLANT SURGERY                  Prosthesis modification     00      9                                          1862a(12)                                                  S                          Y1  9      02000010120000101        N                           
D5899001003UNSPECIFIED REMOVABLE PROSTHODONTIC PROCEDURE, BY REPORT                        Removable prosthodontic proc00      9                                          1862a(12)                                                  S                          Y1  9      01986010119960101        N                           
D5911001003FACIAL MOULAGE (SECTIONAL)                                                      Facial moulage sectional    13      A                  2130 A  2136                                                                       D                          Y1  9      01985010119930101        N                           
D5912001003FACIAL MOULAGE (COMPLETE)                                                       Facial moulage complete     13      A                  2130 A                                                                             D                          Y1  9      01985010119930101        N                           
D5913001003NASAL PROSTHESIS                                                                Nasal prosthesis            00      9                                                                            21087                    I                          Y1  9      01985010119960101        N                           
D5914001003AURICULAR PROSTHESIS                                                            Auricular prosthesis        00      9                                                                            21086                    I                          Y1  9      01985010119960101        N                           
D5915001003ORBITAL PROSTHESIS                                                              Orbital prosthesis          00      9                                                                            L8611                    I                          Y1  9      01985010119960101        N                           
D5916001003OCULAR PROSTHESIS                                                               Ocular prosthesis           00      9                                                                             CPT V2623V2629          I                          Y1  9      01985010119960101        N                           
D5919001003FACIAL PROSTHESIS                                                               Facial prosthesis           00      9                                                                            21088                    I                          Y1  9      01985010119960101        N                           
D5922001003NASAL SEPTAL PROSTHESIS                                                         Nasal septal prosthesis     00      9                                                                            30220                    I                          Y1  9      01992010119960101        N                           
D5923001003OCULAR PROSTHESIS, INTERIM                                                      Ocular prosthesis interim   00      9                                                                            92330                    I                          Y1  9      01992010119960101        N                           
D5924001003CRANIAL PROSTHESIS                                                              Cranial prosthesis          00      9                                                                            62143                    I                          Y1  9      01992010119960101        N                           
D5925001003FACIAL AUGMENTATION IMPLANT PROSTHESIS                                          Facial augmentation implant 00      9                                                                            21208                    I                          Y1  9      01992010119960101        N                           
D5926001003NASAL PROSTHESIS, REPLACEMENT                                                   Replacement nasal prosthesis00      9                                                                            21087                    I                          Y1  9      01992010119960101        N                           
D5927001003AURICULAR PROSTHESIS, REPLACEMENT                                               Auricular replacement       00      9                                                                            21086                    I                          Y1  9      01992010119960101        N                           
D5928001003ORBITAL PROSTHESIS, REPLACEMENT                                                 Orbital replacement         00      9                                                                            67550                    I                          Y1  9      01992010119960101        N                           
D5929001003FACIAL PROSTHESIS, REPLACEMENT                                                  Facial replacement          00      9                                                                            21088                    I                          Y1  9      01992010119960101        N                           
D5931001003OBTURATOR PROSTHESIS, SURGICAL                                                  Surgical obturator          00      9                                                                            21079                    I                          Y1  9      01985010119960101        N                           
D5932001003OBTURATOR PROSTHESIS, DEFINITIVE                                                Postsurgical obturator      00      9                                                                            21080                    I                          Y1  9      01985010119960101        N                           
D5933001003OBTURATOR PROSTHESIS, MODIFICATION                                              Refitting of obturator      00      9                                                                            21080                    I                          Y1  9      01985010119960101        N                           
D5934001003MANDIBULAR RESECTION PROSTHESIS WITH GUIDE FLANGE                               Mandibular flange prosthesis00      9                                                                            21081                    I                          Y1  9      01985010119960101        N                           
D5935001003MANDIBULAR RESECTION PROSTHESIS WITHOUT GUIDE FLANGE                            Mandibular denture prosth   00      9                                                                            21081                    I                          Y1  9      01985010119960101        N                           
D5936001003OBTURATOR/PROSTHESIS, INTERIM                                                   Temp obturator prosthesis   00      9                                                                            21079                    I                          Y1  9      01992010119960101        N                           
D5937001003TRISMUS APPLIANCE (NOT FOR TM TREATMENT)                                        Trismus appliance           00      9                  2130                                                                               I                          Y1  9      01992010119960101        N                           
D5951001003FEEDING AID                                                                     Feeding aid                 13      A                  2336    2130                                                                       D                          Y1  9      01985010119930101        N                           
D5952001003SPEECH AID PROSTHESIS, PEDIATRIC                                                Pediatric speech aid        00      9                                                                            21084                    I                          Y1  9      01985010119960101        N                           
D5953001003SPEECH AID PROSTHESIS, ADULT                                                    Adult speech aid            00      9                                                                            21084                    I                          Y1  9      01985010119960101        N                           
D5954001003PALATAL AUGMENTATION PROSTHESIS                                                 Superimposed prosthesis     00      9                                                                            21082                    I                          Y1  9      01985010119960101        N                           
D5955001003PALATAL LIFT PROSTHESIS, DEFINITIVE                                             Palatal lift prosthesis     00      9                                                                            21083                    I                          Y1  9      01985010119960101        N                           
D5958001003PALATAL LIFT PROSTHESIS, INTERIM                                                Intraoral con def inter plt 00      9                                                                            21083                    I                          Y1  9      01992010119960101        N                           
D5959001003PALATAL LIFT PROSTHESIS, MODIFICATION                                           Intraoral con def mod palat 00      9                                                                            21083                    I                          Y1  9      01992010119960101        N                           
D5960001003SPEECH AID PROSTHESIS, MODIFICATION                                             Modify speech aid prosthesis00      9                                                                            21084                    I                          Y1  9      01992010119960101        N                           
D5982001003SURGICAL STENT                                                                  Surgical stent              00      9                                                                            21085                    I                          Y1  9      01985010119960101        N                           
D5983001003RADIATION CARRIER                                                               Radiation applicator        13      A                  2336    2136                                                                       D                          Y1  9      01985010119930101        N                           
D5984001003RADIATION SHIELD                                                                Radiation shield            13      A                  2336    2136                                                                       D                          Y1  9      01985010119930101        N                           
D5985001003RADIATION CONE LOCATOR                                                          Radiation cone locator      13      A                  2336    2136                                                                       D                          Y1  9      01985010119930101        N                           
D5986001003FLUORIDE GEL CARRIER                                                            Fluoride applicator         00      9                                          1862a(12)                                                  S                          Y1  9      01985010119960101        N                           
D5987001003COMMISSURE SPLINT                                                               Commissure splint           13      A                  2136    2336                                                                       D                          Y1  9      01992010119960101        N                           
D5988001003SURGICAL SPLINT                                                                 Surgical splint             13      A                                                                             CPT                     I                          Y1  9      01992010119960101        N                           
D5999001003UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT                                 Maxillofacial prosthesis    00      9                                                                            CPT                      I                          Y1  9      01986010119960101        N                           
D6010001003SURGICAL PLACEMENT OF IMPLANT BODY:  ENDOSTEAL IMPLANT                          Odontics endosteal implant  00      9                                                                            21248                    I                          Y1  2      01996010119960101        N                           
D6020001003ABUTMENT PLACEMENT OR SUBSTITUTION:  ENDOSTEAL IMPLANT                          Odontics abutment placement 00      9                                                                            21248                    I                          Y1  2      0199601012005010120041231N                           
D6040001003SURGICAL PLACEMENT:  EPOSTEAL IMPLANT                                           Odontics eposteal implant   00      9                                                                            21245                    I                          Y1  2      01992010119960101        N                           
D6050001003SURGICAL PLACEMENT:  TRANSOSTEAL IMPLANT                                        Odontics transosteal implnt 00      9                                                                            21244                    I                          Y1  2      01992010119960101        N                           
D6053001003IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR COMPLETELY EDENTULOUS ARCH     Implnt/abtmnt spprt remv dnt00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6054001003IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH      Implnt/abtmnt spprt remvprtl00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6055001003DENTAL IMPLANT SUPPORTED CONNECTING BAR                                         Implant connecting bar      00      9                  2136                                                                               I                          Y1  9      01992010119960101        N                           
D6056001003PREFABRICATED ABUTMENT - INCLUDES PLACEMENT                                     Prefabricated abutment      00      9                  2136                                                                               M                          Y1  9      02000010120050101        N                           
D6057001003CUSTOM ABUTMENT - INCLUDES PLACEMENT                                            Custom abutment             00      9                  2136                                                                               M                          Y1  9      02000010120050101        N                           
D6058001003ABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN                                      Abutment supported crown    00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6059001003ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (HIGH NOBLE METAL)            Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6060001003ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (PREDOMINANTLY BASE METAL)    Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6061001003ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (NOBLE METAL)                 Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6062001003ABUTMENT SUPPORTED CAST METAL CROWN (HIGH NOBLE METAL)                          Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6063001003ABUTMENT SUPPORTED CAST METAL CROWN (PREDOMINANTLY BASE METAL)                  Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6064001003ABUTMENT SUPPORTED CAST METAL CROWN (NOBLE METAL)                               Abutment supported mtl crown00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6065001003IMPLANT SUPPORTED PORCELAIN/CERAMIC CROWN                                       Implant supported crown     00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6066001003IMPLANT SUPPORTED PORCELAIN FUSED TO METAL CROWN (TITANIUM, TITANIUM ALLOY,     Implant supported mtl crown 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6066002004HIGH NOBLE METAL)                                                                                                                                                                                                                                                                                                    
D6067001003IMPLANT SUPPORTED METAL CROWN (TITANIUM, TITANIUM ALLOY, HIGH NOBLE METAL)      Implant supported mtl crown 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6068001003ABUTMENT SUPPORTED RETAINER FOR PORCELAIN/CERAMIC FPD                           Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6069001003ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (HIGH NOBLE METAL) Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6070001003ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (PREDOMINANTLY     Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6070002004BASE METAL)                                                                                                                                                                                                                                                                                                          
D6071001003ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (NOBLE METAL)      Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6072001003ABUTMENT SUPPORTED RETAINER FOR CAST  METAL FPD (HIGH NOBLE METAL)              Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6073001003ABUTMENT SUPPORTED RETAINER FOR CAST  METAL FPD (PREDOMINANTLY BASE METAL)      Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6074001003ABUTMENT SUPPORTED RETAINER FOR CAST  METAL FPD (NOBLE METAL)                   Abutment supported retainer 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6075001003IMPLANT SUPPORTED RETAINER FOR CERAMIC FPD                                      Implant supported retainer  00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6076001003IMPLANT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (TITANIUM, TITANIUM Implant supported retainer  00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6076002004ALLOY, OR HIGH NOBLE METAL)                                                                                                                                                                                                                                                                                          
D6077001003IMPLANT SUPPORTED RETAINER FOR CAST METAL FPD (TITANIUM, TITANIUM ALLOY, OR     Implant supported retainer  00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6077002004HIGH NOBLE METAL)                                                                                                                                                                                                                                                                                                    
D6078001003IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR COMPLETELY EDENTULOUS ARCH         Implnt/abut suprtd fixd dent00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6079001003IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH          Implnt/abut suprtd fixd dent00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6080001003IMPLANT MAINTENANCE PROCEDURES, INCLUDING: REMOVAL OF PROSTHESIS, CLEANSING OF  Implant maintenance         00      9                  2136                                                                               I                          Y1  2      01992010119960101        N                           
D6080002004PROSTHESIS AND ABUTMEN REINSERTION OF PROSTHESIS                                                                                                                                                                                                                                                                     
D6090001003REPAIR IMPLANTSUPPORTED PROSTHESIS BY REPORT                                    Repair implant              00      9                                                                            21299                    I                          Y1  9      01992010119960101        N                           
D6094001003ABUTMENT SUPPORTED CROWN - (TITANIUM)                                           Abut support crown titanium 00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D6095001003REPAIR IMPLANT ABUTMENT, BY REPORT                                              Odontics repr abutment      00      9                                                                            21299                    I                          Y1  9      01996010119960101        N                           
D6100001003IMPLANT REMOVAL, BY REPORT                                                      Removal of implant          00      9                                                                            21299                    I                          Y1  9      01992010119960101        N                           
D6190001003RADIOGRAPHIC/SURGICAL IMPLANT INDEX, BY REPORT                                  Radio/surgical implant index00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D6194001003ABUTMENT SUPPORTED RETAINER CROWN FOR FPD - (TITANIUM)                          Abut support retainer titani00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D6199001003UNSPECIFIED IMPLANT PROCEDURE, BY REPORT                                        Implant procedure           00      9                                                                            21299                    I                          Y1  9      01992010119960101        N                           
D6205001003PONTIC - INDIRECT RESIN BASED COMPOSITE                                         Pontic-indirect resin based 00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D6210001003PONTIC-CAST HIGH NOBLE METAL                                                    Prosthodont high noble metal00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6211001003PONTIC-CAST PREDOMINANTLY BASE METAL                                            Bridge base metal cast      00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6212001003PONTIC-CAST NOBLE METAL                                                         Bridge noble metal cast     00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6214001003PONTIC - TITANIUM                                                               Pontic titanium             00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D6240001003PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL                                      Bridge porcelain high noble 00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6241001003PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL                              Bridge porcelain base metal 00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6242001003PONTIC-PORCELAIN FUSED TO NOBLE METAL                                           Bridge porcelain nobel metal00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6245001003PONTIC - PORCELAIN/CERAMIC                                                      Bridge porcelain/ceramic    00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6250001003PONTIC-RESIN WITH HIGH NOBLE METAL                                              Bridge resin w/high noble   00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6251001003PONTIC-RESIN WITH PREDOMINANTLY BASE METAL                                      Bridge resin base metal     00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6252001003PONTIC-RESIN WITH NOBLE METAL                                                   Bridge resin w/noble metal  00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6253001003PROVISIONAL PONTIC                                                              Provisional pontic          00      9                                          1862a(12)                                                  S                          Y1  9      02003010120030101        N                           
D6519001003INLAY/ONLAY - PORCELAIN/CERAMIC                                                 Inlay/onlay porce/ceramic   00      9                  2136                                                                               M                          Y1  9      0200001012003010120021231N                           
D6520001003INLAY-METALLIC-TWO SURFACES                                                     Dental retainer two surfaces00      9                                          1862a(12)                                                  S                          Y1  9      0198401012003010120021231N                           
D6530001003INLAY-METALLIC-THREE OR MORE SURFACES                                           Retainer metallic 3+ surface00      9                                          1862a(12)                                                  S                          Y1  9      0198401012003010120021231N                           
D6543001003ONLAY-METALLIC - THREE SURFACES                                                 Dental retainr onlay 3 surf 00      9                                          1862a(12)                                                  S                          Y1  9      0199601012003010120021231N                           
D6544001003ONLAY-METALLIC - FOUR OR MORE SURFACES                                          Dental retainr onlay 4/more 00      9                                          1862a(12)                                                  S                          Y1  9      0199601012003010120021231N                           
D6545001003RETAINER-CAST METAL FOR RESIN BONDED FIXED PROSTHESIS                           Dental retainr cast metl    00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6548001003RETAINER - PORCELAIN/CERAMIC FOR RESIN BONDED FIXED PROSTHESIS                  Porcelain/ceramic retainer  00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6600001003INLAY-PORCELAIN/CERAMIC, TWO SURFACES                                           Porcelain/ceramic inlay 2srf00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6601001003INLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES                               Porc/ceram inlay >= 3 surfac00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6602001003INLAY - CAST HIGH NOBLE METAL, TWO SURFACES                                     Cst hgh nble mtl inlay 2 srf00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6603001003INLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES                           Cst hgh nble mtl inlay >=3sr00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6604001003INLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES                             Cst bse mtl inlay 2 surfaces00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6605001003INLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES                   Cst bse mtl inlay >= 3 surfa00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6606001003INLAY - CAST NOBLE METAL, TWO SURFACES                                          Cast noble metal inlay 2 sur00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6607001003INLAY - CAST NOBLE METAL, THREE OR MORE SURFACES                                Cst noble mtl inlay >=3 surf00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6608001003ONLAY - PORCELAIN/CERAMIC, TWO SURFACES                                         Onlay porc/crmc 2 surfaces  00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6609001003ONLAY - PORCELAIN/CERAMIC, THREE OR MORE SURFACES                               Onlay porc/crmc >=3 surfaces00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6610001003ONLAY - CAST HIGH NOBLE METAL, TWO SURFACES                                     Onlay cst hgh nbl mtl 2 srfc00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6611001003ONLAY - CAST HIGH NOBLE METAL, THREE OR MORE SURFACES                           Onlay cst hgh nbl mtl >=3srf00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6612001003ONLAY - CAST PREDOMINANTLY BASE METAL, TWO SURFACES                             Onlay cst base mtl 2 surface00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6613001003ONLAY - CAST PREDOMINANTLY BASE METAL, THREE OR MORE SURFACES                   Onlay cst base mtl >=3 surfa00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6614001003ONLAY - CAST NOBLE METAL, TWO SURFACES                                          Onlay cst nbl mtl 2 surfaces00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6615001003ONLAY - CAST NOBLE METAL, THREE OR MORE SURFACES                                Onlay cst nbl mtl >=3 surfac00      9                  2136                                                                               M                          Y1  9      02003010120030101        N                           
D6624001003INLAY - TITANIUM                                                                Inlay titanium              00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D6634001003ONLAY - TITANIUM                                                                Onlay titanium              00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D6710001003CROWN - INDIRECT RESIN BASED COMPOSITE                                          Crown-indirect resin based  00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D6720001003CROWN-RESIN WITH HIGH NOBLE METAL                                               Retain crown resin w hi nble00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6721001003CROWN-RESIN WITH PREDOMINANTLY BASE METAL                                       Crown resin w/base metal    00      9                                          1862a(12)                                                  S                          Y1  9      01986010119960101        N                           
D6722001003CROWN-RESIN WITH NOBLE METAL                                                    Crown resin w/noble metal   00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6740001003CROWN - PORCELAIN/CERAMIC                                                       Crown porcelain/ceramic     00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6750001003CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL                                       Crown porcelain high noble  00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6751001003CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL                               Crown porcelain base metal  00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6752001003CROWN-PORCELAIN FUSED TO NOBLE METAL                                            Crown porcelain noble metal 00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6780001003CROWN-3/4 CAST HIGH NOBLE METAL                                                 Crown 3/4 high noble metal  00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6781001003CROWN - 3/4 CAST PREDOMINANTLY BASED METAL                                      Crown 3/4 cast based metal  00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6782001003CROWN - 3/4 CAST NOBLE METAL                                                    Crown 3/4 cast noble metal  00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6783001003CROWN - 3/4 PORCELAIN/CERAMIC                                                   Crown 3/4 porcelain/ceramic 00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6790001003CROWN-FULL CAST HIGH NOBLE METAL                                                Crown full high noble metal 00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6791001003CROWN-FULL CAST PREDOMINANTLY BASE METAL                                        Crown full base metal cast  00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6792001003CROWN-FULL CAST NOBLE METAL                                                     Crown full noble metal cast 00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D6793001003PROVISIONAL RETAINER CROWN                                                      Provisional retainer crown  00      9                                          1862a(12)                                                  S                          Y1  9      02003010120030101        N                           
D6794001003CROWN - TITANIUM                                                                Crown titanium              00      9                                          1862a(12)                                                  S                          Y1  9      02005010120050101        N                           
D6920001003CONNECTOR BAR                                                                   Dental connector bar        13      A50-26             2336    2136                                                                       D                          Y1  9      01996010119960101        N                           
D6930001003RECEMENT BRIDGE                                                                 Dental recement bridge      00      9                                          1862a(12)                                                  S                          Y1  9      01982010119960101        N                           
D6940001003STRESS BREAKER                                                                  Stress breaker              00      9                                          1862a(12)                                                  S                          Y1  9      01982010119960101        N                           
D6950001003PRECISION ATTACHMENT                                                            Precision attachment        00      9                                          1862a(12)                                                  S                          Y1  9      01982010119960101        N                           
D6970001003CAST POST AND CORE IN ADDITION TO BRIDGE RETAINER                               Post & core plus retainer   00      9                                          1862a(12)                                                  S                          Y1  9      01986010119960101        N                           
D6971001003CAST POST AS PART OF BRIDGE RETAINER                                            Cast post bridge retainer   00      9                                          1862a(12)                                                  S                          Y1  9      01986010119960101        N                           
D6972001003PREFABRICATED POST AND CORE IN ADDITION TO BRIDGE RETAINER                      Prefab post & core plus reta00      9                                          1862a(12)                                                  S                          Y1  9      01986010119960101        N                           
D6973001003CORE BUILD UP FOR RETAINER, INCLUDING ANY PINS                                  Core build up for retainer  00      9                                          1862a(12)                                                  S                          Y1  9      01992010119960101        N                           
D6975001003COPING-METAL                                                                    Coping metal                00      9                                          1862a(12)                                                  S                          Y1  9      01992010119960101        N                           
D6976001003EACH ADDITIONAL CAST POST - SAME TOOTH                                          Each addtnl cast post       00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6977001003EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH                                 Each addtl prefab post      00      9                  2136                                                                               M                          Y1  9      02000010120000101        N                           
D6980001003BRIDGE REPAIR, BY REPORT                                                        Bridge repair               00      9                                          1862a(12)                                                  S                          Y1  9      01986010119960101        N                           
D6985001003PEDIATRIC PARTIAL DENTURE, FIXED                                                Pediatric partial denture fx00      9                                          1862a(12)                                                  S                          Y1  9      02003010120030101        N                           
D6999001003UNSPECIFIED FIXED PROSTHODONTIC PROCEDURE, BY REPORT                            Fixed prosthodontic proc    00      9                                          1862a(12)                                                  S                          Y1  9      01984010119960101        N                           
D7110001003SINGLE TOOTH                                                                    Oral surgery single tooth   13      A                  2136    2336                                                                       D                          Y1  2      0198401012003010120021231N                           
D7111001003EXTRACTION, CORONAL REMNANTS - DECIDUOUS TOOTH                                  Extraction coronal remnants 13      A                  2336                                                                               D                          Y1  2      02003010120050101        N                           
D7120001003EACH ADDITIONAL TOOTH                                                           Each add tooth extraction   13      A                  2136    2336                                                                       D                          Y1  2      0198401012003010120021231N                           
D7130001003ROOT REMOVAL-EXPOSED ROOTS                                                      Tooth root removal          13      A                  2136    2336                                                                       D                          Y1  2      0198601012003010120021231N                           
D7140001003EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL)    Extraction erupted tooth/exr13      A                  2336                                                                               D                          Y1  2      02003010120030101        N                           
D7210001003SURGICAL REMOVAL OF ERUPTED TOOTH REQUIRING ELEVATION OF MUCOPERIOSTEAL FLAP    Rem imp tooth w mucoper flp 13      A                  2336    2136                                                                       D                          Y1  2      01984010119930101        N                           
D7210002004AND REMOVAL OF BONE AND/OR SECTION OF TOOTH                                                                                                                                                                                                                                                                          
D7220001003REMOVAL OF IMPACTED TOOTH-SOFT TISSUE                                           Impact tooth remov soft tiss13      A                  2336    2136                                                                       D                          Y1  2      01984010119930101        N                           
D7230001003REMOVAL OF IMPACTED TOOTH-PARTIALLY BONY                                        Impact tooth remov part bony13      A                  2336    2136                                                                       D                          Y1  2      01984010119930101        N                           
D7240001003REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY                                       Impact tooth remov comp bony13      A                  2336    2136                                                                       D                          Y1  2      01984010119930101        N                           
D7241001003REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY, WITH UNUSUAL SURGICAL COMPLICATIONS  Impact tooth rem bony w/comp13      A                  2336    2136                                                                       D                          Y1  2      01984010119930101        N                           
D7250001003SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)                    Tooth root removal          13      A                  2336    2136                                                                       D                          Y1  2      01984010119930101        N                           
D7260001003ORAL ANTRAL FISTULA CLOSURE                                                     Oral antral fistula closure 13      A                  2336    2136                                                                       D                          Y1  2      01984010119930101        N                           
D7261001003PRIMARY CLOSURE OF A SINUS PERFORATION                                          Primary closure sinus perf  13      A                  2336                                                                               D                          Y1  2      02003010120030101        N                           
D7270001003TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED  Tooth reimplantation        00      9                                          1862a(12)                                                  S                          Y1  2      01984010120030101        N                           
D7270002004TOOTH                                                                                                                                                                                                                                                                                                                
D7272001003TOOTH TRANSPLANTATION (INCLUDES REIMPLANTATION FROM ONE SITE TO ANOTHER AND     Tooth transplantation       00      9                                          1862a(12)                                                  S                          Y1  2      01982010119960101        N                           
D7272002004SPLINTING AND/OR STABILIZATION)                                                                                                                                                                                                                                                                                      
D7280001003SURGICAL ACCESS OF AN UNERUPTED TOOTH                                           Exposure impact tooth orthod00      9                                          1862a(12)                                                  S                          Y1  2      01984010120030101        N                           
D7281001003SURGICAL EXPOSURE OF IMPACTED OR UNERUPTED TOOTH TO AID ERUPTION                Exposure tooth aid eruption 00      9                                          1862a(12)                                                  S                          Y1  2      0198401012005010120041231N                           
D7282001003MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION                  Mobilize erupted/malpos toot00      9                                          1862a(12)                                                  S                          Y1  2      02003010120030101        N                           
D7283001003PLACEMENT OF DEVICE TO FACILITATE ERUPTION OF IMPACTED TOOTH                    Place device impacted tooth 00      9                                                                                                     C                          Y1  9      02005010120050101        N                           
D7285001003BIOPSY OF ORAL TISSUE - HARD (BONE, TOOTH)                                      Biopsy of oral tissue hard  00      9                                                                            20220202252024020245     I                          Y1  2      01984010120000101        N                           
D7286001003BIOPSY OF ORAL TISSUE - SOFT                                                    Biopsy of oral tissue soft  00      9                                                                            40808                    I                          Y1  2      01984010120050101        N                           
D7287001003EXFOLIATIVE CYTOLOGICAL SAMPLE COLLECTION                                       Exfoliative cytolog collect 00      9                                                                                                     I                          Y1  2      02003010120050101        N                           
D7288001003BRUSH BIOPSY - TRANSEPITHELIAL SAMPLE COLLECTION                                Brush biopsy                00      9                                                                                                     C                          Y1  2      02005010120050101        N                           
D7290001003SURGICAL REPOSITIONING OF TEETH                                                 Repositioning of teeth      00      9                                          1862a(12)                                                  S                          Y1  2      01982010119960101        N                           
D7291001003TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT                      Transseptal fiberotomy      13      A                  2136    2336                                                                       D                          Y1  2      01986010120030101        N                           
D7310001003ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - PER QUADRANT                    Alveoplasty w/ extraction   00      9                                                                            41874                    I                          Y1  2      01984010119960101        N                           
D7311001003ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH     Alveoloplasty w/extract 1-3 00      9                                          1862a(12)                                                  S                          Y1  2      02005010120050101        N                           
D7311002004SPACES, PER QUADRANT                                                                                                                                                                                                                                                                                                 
D7320001003ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - PER QUADRANT                Alveoplasty w/o extraction  00      9                                                                            41870                    I                          Y1  2      01984010119960101        N                           
D7321001003ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH Alveoloplasty not w/extracts00      9                                                                                                     C                          Y1  2      02005010120050101        N                           
D7321002004SPACES, PER QUADRANT                                                                                                                                                                                                                                                                                                 
D7340001003VESTIBULOPLASTY-RIDGE EXTENSION (SECOND EPITHELIALIZATION)                      Vestibuloplasty ridge extens00      9                                                                            40840408424084340844     I                          Y1  2      01984010119960101        N                           
D7350001003VESTIBULOPLASTY-RIDGE EXTENSION (INCLUDING SOFT TISSUE GRAFTS, MUSCLE           Vestibuloplasty exten graft 00      9                                                                            40845                    I                          Y1  2      01984010119960101        N                           
D7350002004RE-ATTACHMENTS, REVISION OF SOFT TISSUE ATTACHMENT, AND MANAGEMENT OF                                                                                                                                                                                                                                                
D7350003004HYPERTROPHIED AND HYPERPLASTIC TISSUE)                                                                                                                                                                                                                                                                               
D7410001003EXCISION OF BENIGN LESION UP TO 1.25 CM                                         Rad exc lesion up to 1.25 cm00      9                                                                            CPT                      I                      0020Y1  2      01982010120030101        N                           
D7411001003EXCISION OF BENIGN LESION GREATER THAN 1.25 CM                                  Excision benign lesion>1.25c00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7412001003EXCISION OF BENIGN LESION, COMPLICATED                                          Excision benign lesion compl00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7413001003EXCISION OF MALIGNANT LESION UP TO 1.25 CM                                      Excision malig lesion<=1.25c00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7414001003EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM                               Excision malig lesion>1.25cm00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7415001003EXCISION OF MALIGNANT LESION, COMPLICATED                                       Excision malig les complicat00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7420001003RADICAL EXCISION-LESION DIAMETER GREATER THAN 1.25 CM                           Lesion > 1.25 cm            00      9                                                                            CPT                      I                      0020Y1  2      0198201012003010120021231N                           
D7430001003EXCISION OF BENIGN TUMOR-LESION DIAMETER UP TO 1.25 CM                          Exc benign tumor  to 1.25 cm00      9                                                                            CPT                      I                      0021Y1  2      0198401012003010120021231N                           
D7431001003EXCISION OF BENIGN TUMOR-LESION DIAMETER GREATER THAN 1.25 CM                   Benign tumor exc > 1.25 cm  00      9                                                                            CPT                      I                      0021Y1  2      0198401012003010120021231N                           
D7440001003EXCISION OF MALIGNANT TUMOR-LESION DIAMETER UP TO 1.25 CM                       Malig tumor exc to 1.25 cm  00      9                                                                            CPT                      I                      0021Y1  2      01984010119960101        N                           
D7441001003EXCISION OF MALIGNANT TUMOR-LESION DIAMETER GREATER THAN 1.25 CM                Malig tumor > 1.25 cm       00      9                                                                            CPT                      I                      0021Y1  2      01984010119960101        N                           
D7450001003REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP T0 1.25 CM       Rem odontogen cyst to 1.25cm00      9                                                                            CPT                      I                      0021Y1  2      01984010120030101        N                           
D7451001003REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN 1.25 CMRem odontogen cyst > 1.25 cm00      9                                                                            CPT                      I                      0021Y1  2      01984010120030101        N                           
D7460001003REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP TO 1.25 CM    Rem nonodonto cyst to 1.25cm00      9                                                                            CPT                      I                      0021Y1  2      01984010120030101        N                           
D7461001003REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN     Rem nonodonto cyst > 1.25 cm00      9                                                                            CPT                      I                      0021Y1  2      01984010120030101        N                           
D74610020041.25 CM                                                                                                                                                                                                                                                                                                              
D7465001003DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHODS, BY REPORT             Lesion destruction          00      9                                                                            41850                    I                          Y1  2      01984010119960101        N                           
D7471001003REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE)                              Rem exostosis any site      00      9                                                                            2103121032               I                          Y1  2      02000010120030101        N                           
D7472001003REMOVAL OF TORUS PALATINUS                                                      Removal of torus palatinus  00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7473001003REMOVAL OF TORUS MANDIBULARIS                                                   Remove torus mandibularis   00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7480001003PARTIAL OSTECTOMY (GUTTERING OR SAUCERIZATION)                                  Partial ostectomy           00      9                                                                            21025                    I                          Y1  2      0198201012003010120021231N                           
D7485001003SURGICAL REDUCTION OF OSSEOUS TUBEROSITY                                        Surg reduct osseoustuberosit00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7490001003RADICAL RESECTION OF MAXILLA OR MANDIBLE                                        Maxilla or mandible resectio00      9                                                                            21095                    I                          Y1  2      01982010120050101        N                           
D7510001003INCISION AND DRAINAGE OF ABSCESS-INTRAORAL SOFT TISSUE                          I&d absc intraoral soft tiss00      9                                                                            41800                    I                          Y1  2      01984010119960101        N                           
D7511001003INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE - COMPLICATED          Incision/drain abscess intra00      9                                                                                                     C                          Y1  2      02005010120050101        N                           
D7511002004(INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES)                                                                                                                                                                                                                                                                       
D7520001003INCISION AND DRAINAGE OF ABSCESS-EXTRAORAL SOFT TISSUE                          I&d abscess extraoral       00      9                                                                            40800                    I                          Y1  2      01984010119960101        N                           
D7521001003INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE - COMPLICATED          Incision/drain abscess extra00      9                                                                                                     C                          Y1  2      02005010120050101        N                           
D7521002004(INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES)                                                                                                                                                                                                                                                                       
D7530001003REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE      Removal fb skin/areolar tiss00      9                                                                            4180541828               I                          Y1  2      01984010120030101        N                           
D7540001003REMOVAL OF REACTION-PRODUCING FOREIGN BODIES-MUSCULOSKELETAL SYSTEM             Removal of fb reaction      00      9                                                                            205204180041806          I                          Y1  2      01984010119960101        N                           
D7550001003PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE                  Removal of sloughed off bone00      9                                                                            20999                    I                          Y1  2      01982010120030101        N                           
D7560001003MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY              Maxillary sinusotomy        00      9                                                                            31020                    I                          Y1  2      01982010119960101        N                           
D7610001003MAXILLA-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT)                           Maxilla open reduct simple  00      9                                                                            CPT                      I                      0022Y1  2      01984010119960101        N                           
D7620001003MAXILLA-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT)                         Clsd reduct simpl maxilla fx00      9                                                                            CPT                      I                      0023Y1  2      01984010119960101        N                           
D7630001003MANDIBLE-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT)                          Open red simpl mandible fx  00      9                                                                            CPT                      I                      0024Y1  2      01984010119960101        N                           
D7640001003MANDIBLE-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT)                        Clsd red simpl mandible fx  00      9                                                                            CPT                      I                      0025Y1  2      01984010119960101        N                           
D7650001003MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION                                      Open red simp malar/zygom fx00      9                                                                            CPT                      I                      0026Y1  2      01984010119960101        N                           
D7660001003MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION                                    Clsd red simp malar/zygom fx00      9                                                                            CPT                      I                      0027Y1  2      01984010119960101        N                           
D7670001003ALVEOLUS - CLOSED REDUCTION, MAY INCLUDE STABILIZATION OF TEETH                 Closd rductn splint alveolus00      9                                                                            CPT                      I                      0028Y1  2      01984010120030101        N                           
D7671001003ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH                   Alveolus open reduction     00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7680001003FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL          Reduct simple facial bone fx00      9                                                                            CPT                      I                      0029Y1  2      01982010119960101        N                           
D7680002004APPROACHES                                                                                                                                                                                                                                                                                                           
D7710001003MAXILLA-OPEN REDUCTION                                                          Maxilla open reduct compound00      9                                                                            21346                    I                          Y1  2      01984010119960101        N                           
D7720001003MAXILLA-CLOSED REDUCTION                                                        Clsd reduct compd maxilla fx00      9                                                                            21345                    I                          Y1  2      01984010119960101        N                           
D7730001003MANDIBLE-OPEN REDUCTION                                                         Open reduct compd mandble fx00      9                                                                            2146121462               I                          Y1  2      01984010119960101        N                           
D7740001003MANDIBLE-CLOSED REDUCTION                                                       Clsd reduct compd mandble fx00      9                                                                            21455                    I                          Y1  2      01984010119960101        N                           
D7750001003MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION                                      Open red comp malar/zygma fx00      9                                                                            2136021365               I                          Y1  2      01984010119960101        N                           
D7760001003MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION                                    Clsd red comp malar/zygma fx00      9                                                                            21355                    I                          Y1  2      01984010119960101        N                           
D7770001003ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH                                Open reduc compd alveolus fx00      9                                                                            21422                    I                          Y1  2      01984010120030101        N                           
D7771001003ALVEOLUS, CLOSED REDUCTION STABILIZATION OF TEETH                               Alveolus clsd reduc stblz te00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7780001003FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL          Reduct compnd facial bone fx00      9                                                                            2143321435               I                          Y1  2      01982010119960101        N                           
D7780002004APPROACHES                                                                                                                                                                                                                                                                                                           
D7810001003OPEN REDUCTION OF DISLOCATION                                                   Tmj open reduct-dislocation 00      9                                                                            21490                    I                          Y1  2      01982010119960101        N                           
D7820001003CLOSED REDUCTION OF DISLOCATION                                                 Closed tmp manipulation     00      9                                                                            21480                    I                          Y1  2      01982010119960101        N                           
D7830001003MANIPULATION UNDER ANESTHESIA                                                   Tmj manipulation under anest00      9                                                                            00190                    I                          Y1  2      01982010119960101        N                           
D7840001003CONDYLECTOMY                                                                    Removal of tmj condyle      00      9                                                                            21050                    I                          Y1  2      01982010119960101        N                           
D7850001003SURGICAL DISCECTOMY; WITH/WITHOUT IMPLANT                                       Tmj meniscectomy            00      9                                                                            21060                    I                          Y1  2      01984010119960101        N                           
D7852001003DISC REPAIR                                                                     Tmj repair of joint disc    00      9                                                                            21299                    I                          Y1  2      01992010119960101        N                           
D7854001003SYNOVECTOMY                                                                     Tmj excisn of joint membrane00      9                                                                            21299                    I                          Y1  2      01992010119960101        N                           
D7856001003MYOTOMY                                                                         Tmj cutting of a muscle     00      9                                                                            21299                    I                          Y1  2      01992010119960101        N                           
D7858001003JOINT RECONSTRUCTION                                                            Tmj reconstruction          00      9                                                                            2124221243               I                          Y1  2      01992010119960101        N                           
D7860001003ARTHROTOMY                                                                      Tmj cutting into joint      00      9                  2336    2136                                                                       I                          Y1  2      01982010119960101        N                           
D7865001003ARTHROPLASTY                                                                    Tmj reshaping components    00      9                                                                            21240                    I                          Y1  2      01992010119960101        N                           
D7870001003ARTHROCENTESIS                                                                  Tmj aspiration joint fluid  00      9                                                                            21060                    I                          Y1  2      01982010119960101        N                           
D7871001003NON-ARTHROSCOPIC LYSIS AND LAVAGE                                               Lysis + lavage w catheters  00      9                                          1862a(12)                                                  S                          Y1  2      02000010120000101        N                           
D7872001003ARTHROSCOPY-DIAGNOSIS, WITH OR WITHOUT BIOPSY                                   Tmj diagnostic arthroscopy  00      9                                                                            29800                    I                          Y1  2      01992010119960101        N                           
D7873001003ARTHROSCOPY-SURGICAL: LAVAGE AND LYSIS OF ADHESIONS                             Tmj arthroscopy lysis adhesn00      9                                                                            29804                    I                          Y1  2      01992010119960101        N                           
D7874001003ARTHROSCOPY-SURGICAL: DISC REPOSITIONING AND STABILIZATION                      Tmj arthroscopy disc reposit00      9                                                                            29804                    I                          Y1  2      01992010119960101        N                           
D7875001003ARTHROSCOPY-SURGICAL: SYNOVECTOMY                                               Tmj arthroscopy synovectomy 00      9                                                                            29804                    I                          Y1  2      01992010119960101        N                           
D7876001003ARTHROSCOPY-SURGICAL: DISCECTOMY                                                Tmj arthroscopy discectomy  00      9                                                                            29804                    I                          Y1  2      01992010119960101        N                           
D7877001003ARTHROSCOPY-SURGICAL: DEBRIDEMENT                                               Tmj arthroscopy debridement 00      9                                                                            29804                    I                          Y1  2      01992010119960101        N                           
D7880001003OCCLUSAL ORTHOTIC APPLIANCE                                                     Occlusal orthotic appliance 00      9                                                                            21499                    I                          Y1  2      01986010119960101        N                           
D7899001003UNSPECIFIED TMD THERAPY, BY REPORT                                              Tmj unspecified therapy     00      9                                                                            21499                    I                          Y1  2      01992010119960101        N                           
D7910001003SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM                                        Dent sutur recent wnd to 5cm00      9                                                                            1201112013               I                          Y1  2      01984010119960101        N                           
D7911001003COMPLICATED SUTURE-UP TO 5 CM                                                   Dental suture wound to 5 cm 00      9                                                                            1205112052               I                          Y1  2      01984010119960101        N                           
D7912001003COMPLICATED SUTURE-GREATER THAN 5 CM                                            Suture complicate wnd > 5 cm00      9                                                                            13132                    I                          Y1  2      01984010119960101        N                           
D7920001003SKIN GRAFT (IDENTIFY DEFECT COVERED, LOCATION, AND TYPE OF GRAFT)               Dental skin graft           00      9                                                                            CPT                      I                      0030Y1  2      01984010119960101        N                           
D7940001003OSTEOPLASTY-FOR ORTHOGNATHIC DEFORMITIES                                        Reshaping bone orthognathic 13      A                  2336    2136                                                                       D                          Y1  2      01982010119930101        N                           
D7941001003OSTEOTOMY - MANDIBULAR RAMI                                                     Bone cutting ramus closed   00      9                                                                            211932119521196          I                          Y1  2      01984010120000101        N                           
D7943001003OSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLUDES OBTAINING THE GRAFT       Cutting ramus open w/graft  00      9                                                                            21194                    I                          Y1  2      01984010120000101        N                           
D7944001003OSTEOTOMY-SEGMENTED OR SUBAPICAL-PER SEXTANT OR QUADRANT                        Bone cutting segmented      00      9                                                                            2119821206               I                          Y1  2      01984010119960101        N                           
D7945001003OSTEOTOMY-BODY OF MANDIBLE                                                      Bone cutting body mandible  00      9                                                                            21193211942119521196     I                          Y1  2      01984010119960101        N                           
D7946001003LEFORT I (MAXILLA-TOTAL)                                                        Reconstruction maxilla total00      9                                                                            21147                    I                          Y1  2      01984010119960101        N                           
D7947001003LEFORT I (MAXILLA-SEGMENTED)                                                    Reconstruct maxilla segment 00      9                                                                            2114521146               I                          Y1  2      01984010119960101        N                           
D7948001003LEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL BONES FOR MIDFACE HYPOPLASIA OR  Reconstruct midface no graft00      9                                                                            21150                    I                          Y1  2      01984010119960101        N                           
D7948002004RETRUSION)-WITHOUT BONE GRAFT                                                                                                                                                                                                                                                                                        
D7949001003LEFORT II OR LEFORT III-WITH BONE GRAFT                                         Reconstruct midface w/graft 00      9                                                                            CPT                      I                      0031Y1  2      01984010119960101        N                           
D7950001003OSSEOUS, OSTEOPERIOSTEAL, OR CARTILAGE GRAFT OF THE MANDIBLE OR FACIAL          Mandible graft              00      9                                                                            21247                    I                          Y1  2      01984010119960101        N                           
D7950002004BONES-AUTOGENOUS OR NONAUTOGENOUS, BY REPORT                                                                                                                                                                                                                                                                         
D7953001003BONE REPLACEMENT GRAFT FOR RIDGE PRESERVATION - PER SITE                        Bone replacement graft      00      9                                          1862a(12)                                                  S                          Y1  2      02005010120050101        N                           
D7955001003REPAIR OF MAXILLOFACIAL SOFT AND/OR HARD TISSUE DEFECT                          Repair maxillofacial defects00      9                                                                            21299                    I                          Y1  2      01982010120050101        N                           
D7960001003FRENULECTOMY (FRENECTOMY OR FRENOTOMY)-SEPARATE PROCEDURE                       Frenulectomy/frenulotomy    00      9                                                                            408194101041115          I                          Y1  2      01984010119960101        N                           
D7963001003FRENULOPLASTY                                                                   Frenuloplasty               00      9                                          1862a(12)                                                  S                          Y1  2      02005010120050101        N                           
D7970001003EXCISION OF HYPERPLASTIC TISSUE-PER ARCH                                        Excision hyperplastic tissue00      9                                                                            CPT                      I                      0032Y1  2      01984010119960101        N                           
D7971001003EXCISION OF PERICORONAL GINGIVA                                                 Excision pericoronal gingiva00      9                                                                            41821                    I                          Y1  2      01986010119960101        N                           
D7972001003SURGICAL REDUCTION OF FIBROUS TUBEROSITY                                        Surg redct fibrous tuberosit00      9                                                                                                     I                          Y1  2      02003010120030101        N                           
D7980001003SIALOLITHOTOMY                                                                  Sialolithotomy              00      9                                                                            423304233542340          I                          Y1  2      01982010119960101        N                           
D7981001003EXCISION OF SALIVARY GLAND, BY REPORT                                           Excision of salivary gland  00      9                                                                            42408                    I                          Y1  2      01982010119960101        N                           
D7982001003SIALODOCHOPLASTY                                                                Sialodochoplasty            00      9                                                                            42500                    I                          Y1  2      01984010119960101        N                           
D7983001003CLOSURE OF SALIVARY FISTULA                                                     Closure of salivary fistula 00      9                                                                            42600                    I                          Y1  2      01982010119960101        N                           
D7990001003EMERGENCY TRACHEOTOMY                                                           Emergency tracheotomy       00      9                                                                            31605                    I                          Y1  2      01982010119960101        N                           
D7991001003CORONOIDECTOMY                                                                  Dental coronoidectomy       00      9                                                                            21070                    I                          Y1  2      01985010119960101        N                           
D7995001003SYNTHETIC GRAFT-MANDIBLE OR FACIAL BONES, BY REPORT                             Synthetic graft facial bones00      9                                                                            21299                    I                          Y1  2      01996010119960101        N                           
D7996001003IMPLANT-MANDIBLE FOR AUGMENTATION PURPOSES (EXCLUDING ALVEOLAR RIDGE), BY REPORTImplant mandible for augment00      9                                                                            21299                    I                          Y1  2      01996010119960101        N                           
D7997001003APPLIANCE REMOVAL (NOT BY DENTIST WHO PLACED APPLIANCE), INCLUDES REMOVAL OF    Appliance removal           00      9                                          1862a(12)                                                  S                          Y1  2      02000010120000101        N                           
D7997002004ARCHBAR                                                                                                                                                                                                                                                                                                              
D7999001003UNSPECIFIED ORAL SURGERY PROCEDURE, BY REPORT                                   Oral surgery procedure      00      9                                                                            21299                    I                          Y1  2      01984010119960101        N                           
D8010001003LIMITED ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION                          Limited dental tx primary   00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8020001003LIMITED ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION                     Limited dental tx transition00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8030001003LIMITED ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION                       Limited dental tx adolescent00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8040001003LIMITED ORTHODONTIC TREATMENT OF THE ADULT DENTITION                            Limited dental tx adult     00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8050001003INTERCEPTIVE ORTHODONTIC TREATMENT OF THE PRIMARY DENTITION                     Intercep dental tx primary  00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8060001003INTERCEPTIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION                Intercep dental tx transitn 00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8070001003COMPREHENSIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION               Compre dental tx transition 00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8080001003COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION                 Compre dental tx adolescent 00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8090001003COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION                      Compre dental tx adult      00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8210001003REMOVABLE APPLIANCE THERAPY                                                     Orthodontic rem appliance tx00      9                                          1862a(12)                                                  S                          Y1  1      01982010119960101        N                           
D8220001003FIXED APPLIANCE THERAPY                                                         Fixed appliance therapy habt00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D8660001003PRE-ORTHODONTIC VISIT                                                           Preorthodontic tx visit     00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8670001003PERIODIC ORTHODONTIC TREATMENT VISIT (AS PART OF CONTRACT)                      Periodic orthodontc tx visit00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8680001003ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONSTRUCTION AND PLACEMENT OF     Orthodontic retention       00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8680002004RETAINER(S))                                                                                                                                                                                                                                                                                                         
D8690001003ORTHODONTIC TREATMENT (ALTERNATIVE BILLING TO A CONTRACT FEE)                   Orthodontic treatment       00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D8691001003REPAIR OF ORTHODONTIC APPLIANCE                                                 Repair ortho appliance      00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D8692001003REPLACEMENT OF LOST OR BROKEN RETAINER                                          Replacement retainer        00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D8999001003UNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT                                    Orthodontic procedure       00      9                                          1862a(12)                                                  S                          Y1  1      01984010119960101        N                           
D9110001003PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN-MINOR PROCEDURES                Tx dental pain minor proc   13      A                  2336    2136                                                                       D                          Y1  1      01984010119960101        N                           
D9210001003LOCAL ANESTHESIA  N0T IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES      Dent anesthesia w/o surgery 00      9                                                                            90784                    I                          Y1  7      01984010119960101        N                           
D9211001003REGIONAL BLOCK ANESTHESIA                                                       Regional block anesthesia   00      9                                                                            01995                    I                          Y1  7      01982010119960101        N                           
D9212001003TRIGEMINAL DIVISION BLOCK ANESTHESIA                                            Trigeminal block anesthesia 00      9                                                                            64400                    I                          Y1  7      01985010119960101        N                           
D9215001003LOCAL ANESTHESIA                                                                Local anesthesia            00      9                                                                            90784                    I                          Y1  7      01985010119960101        N                           
D9220001003DEEP SEDATION/GENERAL ANESTHESIA-FIRST 30 MINUTES                               General anesthesia          00      9                                                                            CPT                      I                      0034Y1  7      01982010120030101        N                           
D9221001003DEEP SEDATION/GENERAL ANESTHESIA-EACH ADDITIONAL 15 MINUTES                     General anesthesia ea ad 15m00      9                  2136    2336                                                                       I                          Y1  7      01992010120030101        N                           
D9230001003ANALGESIA, ANXIOLYSIS, INHALATION OF NITROUS OXIDE                              Analgesia                   13      A                  2136    2336                                                                       D                          Y1  7      01982010120000101        N                           
D9241001003INTRAVENOUS CONSCIOUS SEDATION/ANALGESIA - FIRST 30 MINUTES                     Intravenous sedation        00      9                                                                            90784                    I                          Y1  7      02000010120030101        N                           
D9242001003INTRAVENOUS CONSCIOUS SEDATION/ANALGESIA - EACH ADDITIONAL 15 MINUTES           IV sedation ea ad 30 m      00      9                                                                            90784                    I                          Y1  7      02000010120030101        N                           
D9248001003NON-INTRAVENOUS CONSCIOUS SEDATION                                              Sedation (non-iv)           00      9                                                                                                     D                      0052Y1  7      02000010120000101        N                           
D9310001003CONSULTATION (DIAGNOSTIC SERVICE PROVIDED BY DENTIST OR PHYSICIAN OTHER THAN    Dental consultation         00      9                                                                            CPT                      I                      0035Y1  3      01982010119960101        N                           
D9310002004PRACTITIONER PROVIDING TREATMENT)                                                                                                                                                                                                                                                                                    
D9410001003HOUSE/EXTENDED CARE FACILITY CALL                                               Dental house call           00      9                                                                            CPT                      I                      0036Y1  1      01984010120000101        N                           
D9420001003HOSPITAL CALL                                                                   Hospital call               00      9                                                                            CPT                      I                      0037Y1  1      01984010119960101        N                           
D9430001003OFFICE VISIT FOR OBSERVATION (DURING REGULARLY SCHEDULED HOURS) NO OTHER        Office visit during hours   00      9                                                                            CPT                      I                      0038Y1  1      01984010119960101        N                           
D9430002004SERVICES PERFORMED                                                                                                                                                                                                                                                                                                   
D9440001003OFFICE VISIT-AFTER REGULARLY SCHEDULED HOURS                                    Office visit after hours    00      9                                                                            99050                    I                          Y1  1      01984010119960101        N                           
D9450001003CASE PRESENTATION, DETAILED AND EXTENSIVE TREATMENT PLANNING                    Case presentation tx plan   00      9                                                                                                     I                          Y1  1      02003010120030101        N                           
D9610001003THERAPEUTIC DRUG INJECTION, BY REPORT                                           Dent therapeutic drug inject00      9                                                                            9078890784               I                          Y1  9      01984010119960101        N                           
D9630001003OTHER DRUGS AND/OR MEDICAMENTS, BY REPORT                                       Other drugs/medicaments     13      A                  2336    2136                                                                       D                          Y1  9      01984010119930101        N                           
D9910001003APPLICATION OF DESENSITIZING MEDICAMENT                                         Dent appl desensitizing med 00      9                                          1862a(12)                                                  S                          Y1  1      01985010119960101        N                           
D9911001003APPLICATION OF DESENSITIZING RESIN FOR CERVICAL AND/OR ROOT SURFACE, PER TOOTH  Appl desensitizing resin    00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D9920001003BEHAVIOR MANAGEMENT, BY REPORT                                                  Behavior management         00      9                                          1862a(12)                                                  S                          Y1  1      01986010119960101        N                           
D9930001003TREATMENT OF COMPLICATIONS (POSTSURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT    Treatment of complications  13      A                  2336    2136                                                                       D                          Y1  1      01984010119930101        N                           
D9940001003OCCLUSAL GUARDS, BY REPORT                                                      Dental occlusal guard       13      A                  2336    2136                                                                       D                          Y1  1      01986010119960101        N                           
D9941001003FABRICATION OF ATHLETIC MOUTHGUARD                                              Fabrication athletic guard  00      9                                          1862a(12)                         21089                    S                          Y1  1      01986010119960101        N                           
D9942001003REPAIR AND/OR RELINE OF OCCLUSAL GUARD                                          Repair/reline occlusal guard00      9                                          1862a(12)                                                  S                          Y1  1      02005010120050101        N                           
D9950001003OCCLUSION ANALYSIS-MOUNTED CASE                                                 Occlusion analysis          13      A                  2336    2136                                                                       D                          Y1  1      01984010119930101        N                           
D9951001003OCCLUSAL ADJUSTMENT-LIMITED                                                     Limited occlusal adjustment 13      A                  2336    2136                                                                       D                          Y1  1      01986010119930101        N                           
D9952001003OCCLUSAL ADJUSTMENT-COMPLETE                                                    Complete occlusal adjustment13      A                  2336    2136                                                                       D                          Y1  1      01986010119930101        N                           
D9970001003ENAMEL MICROABRASION                                                            Enamel microabrasion        00      9                                          1862a(12)                                                  S                          Y1  1      01996010119960101        N                           
D9971001003ODONTOPLASTY 1 - 2 TEETH; INCLUDES REMOVAL OF ENAMEL PROJECTIONS                Odontoplasty 1-2 teeth      00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D9972001003EXTERNAL BLEACHING  - PER ARCH                                                  Extrnl bleaching per arch   00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D9973001003EXTERNAL BLEACHING - PER TOOTH                                                  Extrnl bleaching per tooth  00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D9974001003INTERNAL BLEACHING - PER TOOTH                                                  Intrnl bleaching per tooth  00      9                                          1862a(12)                                                  S                          Y1  1      02000010120000101        N                           
D9999001003UNSPECIFIED ADJUNCTIVE PROCEDURE, BY REPORT                                     Adjunctive procedure        00      9                                                                            21499                    I                          Y1  1      01984010119960101        N                           
E0100001003CANE, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR FIXED, WITH TIP            Cane adjust/fixed with tip  32      A60-3  60-9        2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0105001003CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR       Cane adjust/fixed quad/3 pro32      A60-15 60-9        2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0105002004FIXED, WITH TIPS                                                                                                                                                                                                                                                                                                     
E0110001003CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, Crutch forearm pair         32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0110002004PAIR, COMPLETE WITH TIPS AND HANDGRIPS                                                                                                                                                                                                                                                                               
E0111001003CRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED,    Crutch forearm each         32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0111002004EACH, WITH TIP AND HANDGRIPS                                                                                                                                                                                                                                                                                         
E0112001003CRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS AND         Crutch underarm pair wood   32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0112002004HANDGRIPS                                                                                                                                                                                                                                                                                                            
E0113001003CRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH, WITH PAD, TIP AND HANDGRIP    Crutch underarm each wood   32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0114001003CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS  Crutch underarm pair no wood32      A60-9              2100.1                                                                             D                          D1E APR    01986010119970101        N                           
E0114002004AND HANDGRIPS                                                                                                                                                                                                                                                                                                        
E0116001003CRUTCH, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, WITH PAD, TIP,          Crutch underarm each no wood32      A60-9              2100.1                                                                             D                          D1E APR    01986010120060101        C                           
E0116002004HANDGRIP, WITH OR WITHOUT SHOCK ABSORBER, EACH                                                                                                                                                                                                                                                                       
E0117001003CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH                           Underarm springassist crutch32      A                  2100.1                                                                             D                          D1E APR    02003010120030101        N                           
E0118001003CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WITHOUT WHEELS, EACH             Crutch substitute           32      A                                                                                                     C                          D1E APR    02004010120040401        N                           
E0130001003WALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT                              Walker rigid adjust/fixed ht32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0135001003WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT                            Walker folding adjust/fixed 32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0140001003WALKER, WITH TRUNK SUPPORT, ADJUSTABLE OR FIXED HEIGHT, ANY TYPE                Walker w trunk support      32      A60-9              2100.1                                                                             D                          D1E APR    02004010120040101        N                           
E0141001003WALKER, RIGID, WHEELED, ADJUSTABLE OR FIXED HEIGHT                              Rigid wheeled walker adj/fix32      A60-9              2100.1                                                                             D                          D1E APR    01986010120040101        N                           
E0142001003RIGID WALKER, WHEELED, WITH SEAT                                                Walker rigid wheeled with se32      A60-9              2100.1                                                                             D                          D1E APR    0198601012004010120031231N                           
E0143001003WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT                            Walker folding wheeled w/o s32      A60-9              2100.1                                                                             D                          D1E APR    01986010120040101        N                           
E0144001003WALKER, ENCLOSED, FOUR SIDED FRAMED, RIGID OR FOLDING, WHEELED WITH POSTERIOR   Enclosed walker w rear seat 36      A60-9              2100.1                                                                             D                          D1E APR    02000010120040101        N                           
E0144002004SEAT                                                                                                                                                                                                                                                                                                                 
E0145001003WALKER, WHEELED, WITH SEAT AND CRUTCH ATTACHMENTS                               Walker whled seat/crutch att36      A60-9              2100.1                                                                             D                          D1E R      0198601012004010120031231N                           
E0146001003FOLDING WALKER, WHEELED, WITH SEAT                                              Folding walker wheels w seat36      A60-9              2100.1                                                                             D                          D1E R      0198601012004010120031231N                           
E0147001003WALKER, HEAVY DUTY, MULTIPLE BRAKING SYSTEM, VARIABLE WHEEL RESISTANCE          Walker variable wheel resist32      A60-15             2100.1                                                                             D                          D1E APR    01986010120040101        N                           
E0148001003WALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDING, ANY TYPE, EACH            Heavyduty walker no wheels  32      A                                                                                                     C                          D1E APR    02001010120010101        N                           
E0149001003WALKER, HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY TYPE                         Heavy duty wheeled walker   32      A                                                                                                     C                          D1E APR    02001010120040101        N                           
E0153001003PLATFORM ATTACHMENT, FOREARM CRUTCH, EACH                                       Forearm crutch platform atta32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0154001003PLATFORM ATTACHMENT, WALKER, EACH                                               Walker platform attachment  32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0155001003WHEEL ATTACHMENT, RIGID PICK-UP WALKER, PER PAIR                                Walker wheel attachment,pair32      A                                                                                                     C                          D1E APR    01986010120000101        N                           
E0156001003SEAT ATTACHMENT, WALKER                                                         Walker seat attachment      32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0157001003CRUTCH ATTACHMENT, WALKER, EACH                                                 Walker crutch attachment    32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0158001003LEG EXTENSIONS FOR WALKER, PER SET OF FOUR (4)                                  Walker leg extenders set of432      A                                                                                                     C                          D1E APR    01986010120000101        N                           
E0159001003BRAKE ATTACHMENT FOR WHEELED WALKER, REPLACEMENT, EACH                          Brake for wheeled walker    32      A                                                                                                     C                          D1E APR    01997010119980101        N                           
E0160001003SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE             Sitz type bath or equipment 32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0161001003SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE, WITH       Sitz bath/equipment w/faucet32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0161002004FAUCET ATTACHMENT/S                                                                                                                                                                                                                                                                                                  
E0162001003SITZ BATH CHAIR                                                                 Sitz bath chair             32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0163001003COMMODE CHAIR, STATIONARY, WITH FIXED ARMS                                      Commode chair stationry fxd 32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0164001003COMMODE CHAIR, MOBILE, WITH FIXED ARMS                                          Commode chair mobile fixed a32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0165001003COMMODE CHAIR, STATIONARY, WITH DETACHABLE ARMS                                 Commode chair stationry det 36      A60-9              2100.1                                                                             D                          D1E R      01986010119960101        N                           
E0166001003COMMODE CHAIR, MOBILE, WITH DETACHABLE ARMS                                     Commode chair mobile detach 36      A60-9              2100.1                                                                             D                          D1E R      01986010119960101        N                           
E0167001003PAIL OR PAN FOR USE WITH COMMODE CHAIR                                          Commode chair pail or pan   32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0168001003COMMODE CHAIR, EXTRA WIDE AND/OR HEAVY DUTY, STATIONARY OR MOBILE, WITH OR      Heavyduty/wide commode chair32      A                                                                                                     C                          D1E APR    02001010120010101        N                           
E0168002004WITHOUT ARMS, ANY TYPE, EACH                                                                                                                                                                                                                                                                                         
E0169001003COMMODE CHAIR WITH SEAT LIFT MECHANISM                                          Seatlift incorp commodechair36      A                                                                                                     C                          D1E R      0200201012006010120051231D                           
E0170001003COMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, ELECTRIC, ANY TYPE           Commode chair electric      36      A                                                                                                     C                          D1E APR    02006010120060101        A                           
E0171001003COMMODE CHAIR WITH INTEGRATED SEAT LIFT MECHANISM, NON-ELECTRIC, ANY TYPE       Commode chair non-electric  36      A                                                                                                     C                          D1E APR    02006010120060101        A                           
E0172001003SEAT LIFT MECHANISM PLACED OVER OR ON TOP OF TOILET, ANY TYPE                   Seat lift mechanism toilet  00      9                                          1861SSA                                                    S                          D1E APR    02006010120060101        A                           
E0175001003FOOT REST, FOR USE WITH COMMODE CHAIR, EACH                                     Commode chair foot rest     32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0176001003AIR PRESSURE PAD OR CUSHION, NONPOSITIONING                                     Air pressre pad/cushion nonp32      A60-9                                                                                                 D                          D1E APR    0199101012005010120041231N                           
E0177001003WATER PRESSURE PAD OR CUSHION, NONPOSITIONING                                   Water press pad/cushion nonp32      A60-9                                                                                                 D                          D1E APR    0199101012005010120041231N                           
E0178001003GEL OR GEL-LIKE PRESSURE PAD OR CUSHION, NONPOSITIONING                         Gel pressre pad/cushion nonp32      A60-9                                                                                                 D                          D1E APR    0199101012005010120041231N                           
E0179001003DRY PRESSURE PAD OR CUSHION, NONPOSITIONING                                     Dry pressre pad/cushion nonp32      A60-9                                                                                                 D                          D1E APR    0199101012005010120041231N                           
E0180001003PRESSURE PAD, ALTERNATING WITH PUMP                                             Press pad alternating w pump36      A60-9              4107.6                                                                             D                          D1E R      01986010119960101        N                           
E0181001003PRESSURE PAD, ALTERNATING WITH PUMP, HEAVY DUTY                                 Press pad alternating w/ pum36      A60-9              4107.6                                                                             D                          D1E R      01986010119960101        N                           
E0182001003PUMP FOR ALTERNATING PRESSURE PAD                                               Pressure pad alternating pum36      A60-9              4107.6                                                                             D                          D1E R      01986010119960101        N                           
E0184001003DRY PRESSURE MATTRESS                                                           Dry pressure mattress       32      A60-9              4107.6                                                                             D                          D1E APR    01986010119960101        N                           
E0185001003GEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH   Gel pressure mattress pad   32      A60-9              4107.6                                                                             D                          D1E APR    01986010119980101        N                           
E0186001003AIR PRESSURE MATTRESS                                                           Air pressure mattress       36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0187001003WATER PRESSURE MATTRESS                                                         Water pressure mattress     36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0188001003SYNTHETIC SHEEPSKIN PAD                                                         Synthetic sheepskin pad     32      A60-9              4107.6                                                                             D                          D1E APR    01986010120010101        N                           
E0189001003LAMBSWOOL SHEEPSKIN PAD, ANY SIZE                                               Lambswool sheepskin pad     32      A60-9              4107.6                                                                             D                          D1E APR    01986010120010101        N                           
E0190001003POSITIONING CUSHION/PILLOW/WEDGE, ANY SHAPE OR SIZE                             Positioning cushion         00      9                  2100.1                                                                             D                          D1E 9      02004010120040101        N                           
E0191001003HEEL OR ELBOW PROTECTOR, EACH                                                   Protector heel or elbow     32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0192001003LOW PRESSURE AND POSITIONING EQUALIZATION PAD, FOR WHEELCHAIR                   Pad wheelchr low press/posit00      9                                                                                                     I                          D1D APR    0198701012005010120041231N                           
E0193001003POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY)                                Powered air flotation bed   36      A                                                                                                     C                          D1E R      01990010119930101        N                           
E0194001003AIR FLUIDIZED BED                                                               Air fluidized bed           36      A60-19                                                                                                D                      0013D1E R      01991010119910101        N                           
E0196001003GEL PRESSURE MATTRESS                                                           Gel pressure mattress       36      A60-9                                                                                                 D                          D1E R      01991010119910101        N                           
E0197001003AIR PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH               Air pressure pad for mattres32      A60-9                                                                                                 D                          D1E APR    01991010119980101        N                           
E0198001003WATER PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH             Water pressure pad for mattr32      A60-9                                                                                                 D                          D1E APR    01991010119980101        N                           
E0199001003DRY PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH               Dry pressure pad for mattres32      A60-9                                                                                                 D                          D1E APR    01991010119980101        N                           
E0200001003HEAT LAMP, WITHOUT STAND (TABLE MODEL), INCLUDES BULB, OR INFRARED ELEMENT      Heat lamp without stand     32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0202001003PHOTOTHERAPY (BILIRUBIN) LIGHT WITH PHOTOMETER                                  Phototherapy light w/ photom36      A                                                                                                     C                          D1E R      01985010119960101        N                           
E0203001003THERAPEUTIC LIGHTBOX, MINIMUM 10,000 LUX, TABLE TOP MODEL                       Therapeutic lightbox tabletp00      960-9                                                                                                 M                          D1E 9      02003010120050101        F                           
E0205001003HEAT LAMP, WITH STAND, INCLUDES BULB, OR INFRARED ELEMENT                       Heat lamp with stand        32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0210001003ELECTRIC HEAT PAD, STANDARD                                                     Electric heat pad standard  32      A60-9                                                                                                 D                          D1E ALPR   01986010120030101        N                           
E0215001003ELECTRIC HEAT PAD, MOIST                                                        Electric heat pad moist     32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0217001003WATER CIRCULATING HEAT PAD WITH PUMP                                            Water circ heat pad w pump  32      A60-9                                                                                                 D                          D1E APR    01997010119970101        N                           
E0218001003WATER CIRCULATING COLD PAD WITH PUMP                                            Water circ cold pad w pump  36      A60-9                                                                                                 D                          D1E APR    01997010119970101        N                           
E0220001003HOT WATER BOTTLE                                                                Hot water bottle            32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0221001003INFRARED HEATING PAD SYSTEM                                                     Infrared heating pad system 00      960-25                                                                                                M                          D1E APR    02002010120050101        N                           
E0225001003HYDROCOLLATOR UNIT, INCLUDES PADS                                               Hydrocollator unit          32      A60-9              2210.3                                                                             D                          D1E APR    01986010119960101        N                           
E0230001003ICE CAP OR COLLAR                                                               Ice cap or collar           32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0231001003NON-CONTACT WOUND WARMING DEVICE (TEMPERATURE CONTROL UNIT, AC ADAPTER AND      Wound warming device        00      9                  2303                                                                               M                          D1E R      02002010120020701        N                           
E0231002004POWER CORD) FOR USE WITH WARMING CARD AND WOUND COVER                                                                                                                                                                                                                                                                
E0232001003WARMING CARD FOR USE WITH THE NON CONTACT WOUND WARMING DEVICE AND NON CONTACT  Warming card for NWT        00      9                  2303                                                                               M                          D1E P      02002010120020701        N                           
E0232002004WOUND WARMING WOUND COVER                                                                                                                                                                                                                                                                                            
E0235001003PARAFFIN BATH UNIT, PORTABLE (SEE MEDICAL SUPPLY CODE A4265 FOR PARAFFIN)       Paraffin bath unit portable 36      A60-9              2210.3                                                                             D                          D1E R      01986010119960101        N                           
E0236001003PUMP FOR WATER CIRCULATING PAD                                                  Pump for water circulating p36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0238001003NON-ELECTRIC HEAT PAD, MOIST                                                    Heat pad non-electric moist 32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0239001003HYDROCOLLATOR UNIT, PORTABLE                                                    Hydrocollator unit portable 32      A60-9              2210.3                                                                             D                          D1E APR    01986010119960101        N                           
E0240001003BATH/SHOWER CHAIR, WITH OR WITHOUT WHEELS, ANY SIZE                             Bath/shower chair           00      960-9                                                                                                 M                          D1E 9      02004010120060101        F                           
E0241001003BATH TUB WALL RAIL, EACH                                                        Bath tub wall rail          00      960-9              2100.1                                                                             M                          D1E APR    01986010119960101        N                           
E0242001003BATH TUB RAIL, FLOOR BASE                                                       Bath tub rail floor         00      960-9              2100.1                                                                             M                          D1E APR    01986010119960101        N                           
E0243001003TOILET RAIL, EACH                                                               Toilet rail                 00      960-9              2100.1                                                                             M                          D1E APR    01986010119960101        N                           
E0244001003RAISED TOILET SEAT                                                              Toilet seat raised          00      960-9                                                                                                 M                          D1E APR    01986010119960101        N                           
E0245001003TUB STOOL OR BENCH                                                              Tub stool or bench          00      960-9                                                                                                 M                          D1E APR    01986010119960101        N                           
E0246001003TRANSFER TUB RAIL ATTACHMENT                                                    Transfer tub rail attachment00      9                                                                                                     C                          D1E APR    01986010119960101        N                           
E0247001003TRANSFER BENCH FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING                Trans bench w/wo comm open  00      960-9                                                                                                 D                          D1E APR    02004010120040101        N                           
E0248001003TRANSFER BENCH, HEAVY DUTY, FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING   HDtrans bench w/wo comm open00      960-9                                                                                                 D                          D1E APR    02004010120040101        N                           
E0249001003PAD FOR WATER CIRCULATING HEAT UNIT                                             Pad water circulating heat u32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0250001003HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITH MATTRESS             Hosp bed fixed ht w/ mattres36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0251001003HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS          Hosp bed fixd ht w/o mattres36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0255001003HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITH MATTRESS   Hospital bed var ht w/ mattr36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0256001003HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESSHospital bed var ht w/o matt36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0260001003HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE      Hosp bed semi-electr w/ matt36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0260002004RAILS, WITH MATTRESS                                                                                                                                                                                                                                                                                                 
E0261001003HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE      Hosp bed semi-electr w/o mat36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0261002004RAILS, WITHOUT MATTRESS                                                                                                                                                                                                                                                                                              
E0265001003HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE Hosp bed total electr w/ mat36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0265002004SIDE RAILS, WITH MATTRESS                                                                                                                                                                                                                                                                                            
E0266001003HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITH ANY TYPE Hosp bed total elec w/o matt36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0266002004SIDE RAILS, WITHOUT MATTRESS                                                                                                                                                                                                                                                                                         
E0270001003HOSPITAL BED, INSTITUTIONAL TYPE INCLUDES: OSCILLATING, CIRCULATING AND STRYKER Hospital bed institutional t00      960-9                                                                                                 M                          D1B R      01986010119930101        N                           
E0270002004FRAME, WITH MATTRESS                                                                                                                                                                                                                                                                                                 
E0271001003MATTRESS, INNERSPRING                                                           Mattress innerspring        32      A60-18 60-9                                                                                           D                          D1B APR    01986010119930101        N                           
E0272001003MATTRESS, FOAM RUBBER                                                           Mattress foam rubber        32      A60-18 60-9                                                                                           D                          D1B APR    01986010119930101        N                           
E0273001003BED BOARD                                                                       Bed board                   00      960-9                                                                                                 M                          D1B APR    01986010119890101        N                           
E0274001003OVER-BED TABLE                                                                  Over-bed table              00      960-9                                                                                                 M                          D1B APR    01986010119890101        N                           
E0275001003BED PAN, STANDARD, METAL OR PLASTIC                                             Bed pan standard            32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0276001003BED PAN, FRACTURE, METAL OR PLASTIC                                             Bed pan fracture            32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0277001003POWERED PRESSURE-REDUCING AIR MATTRESS                                          Powered pres-redu air mattrs36      A60-9                                                                                                 D                          D1E R      01992010119980101        N                           
E0280001003BED CRADLE, ANY TYPE                                                            Bed cradle                  32      A                                                                                                     C                          D1B APR    01986010119890101        N                           
E0290001003HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITH MATTRESS                   Hosp bed fx ht w/o rails w/m36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0291001003HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITHOUT MATTRESS                Hosp bed fx ht w/o rail w/o 36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0292001003HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITH MATTRESS         Hosp bed var ht w/o rail w/o36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0293001003HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITHOUT SIDE RAILS, WITHOUT MATTRESS      Hosp bed var ht w/o rail w/ 36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0294001003HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS,     Hosp bed semi-elect w/ mattr36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0294002004WITH MATTRESS                                                                                                                                                                                                                                                                                                        
E0295001003HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS,     Hosp bed semi-elect w/o matt36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0295002004WITHOUT MATTRESS                                                                                                                                                                                                                                                                                                     
E0296001003HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS). WITHOUT SIDE  Hosp bed total elect w/ matt36      A60-18             2100.1                                                                             D                          D1B R      01991010119920101        N                           
E0296002004RAILS, WITH MATTRESS                                                                                                                                                                                                                                                                                                 
E0297001003HOSPITAL BED, TOTAL ELECTRIC (HEAD, FOOT AND HEIGHT ADJUSTMENTS), WITHOUT SIDE  Hosp bed total elect w/o mat36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0297002004RAILS, WITHOUT MATTRESS                                                                                                                                                                                                                                                                                              
E0300001003PEDIATRIC CRIB, HOSPITAL GRADE, FULLY ENCLOSED                                  Enclosed ped crib hosp grade32      A                                                                                                     C                          D1B APR    02004010120040101        N                           
E0301001003HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350     HD hosp bed, 350-600 lbs    36      A60-18                                                                                                D                          D1B R      02004010120040101        N                           
E0301002004POUNDS, BUT LESS THAN OR EQUAL TO 600 POUNDS, WITH ANY TYPE SIDE RAILS, WITHOUT                                                                                                                                                                                                                                      
E0301003004MATTRESS                                                                                                                                                                                                                                                                                                             
E0302001003HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN   Ex hd hosp bed > 600 lbs    36      A60-18                                                                                                D                          D1B R      02004010120040101        N                           
E0302002004600 POUNDS, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS                                                                                                                                                                                                                                                               
E0303001003HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350     Hosp bed hvy dty xtra wide  36      A60-18                                                                                                D                          D1B R      02004010120040101        N                           
E0303002004POUNDS, BUT LESS THAN OR EQUAL TO 600 POUNDS, WITH ANY TYPE SIDE RAILS, WITH                                                                                                                                                                                                                                         
E0303003004MATTRESS                                                                                                                                                                                                                                                                                                             
E0304001003HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN   Hosp bed xtra hvy dty x wide36      A60-18                                                                                                D                          D1B R      02004010120040101        N                           
E0304002004600 POUNDS, WITH ANY TYPE SIDE RAILS, WITH MATTRESS                                                                                                                                                                                                                                                                  
E0305001003BED SIDE RAILS, HALF LENGTH                                                     Rails bed side half length  36      A60-18                                                                                                D                          D1B R      01986010119900101        N                           
E0310001003BED SIDE RAILS, FULL LENGTH                                                     Rails bed side full length  32      A60-18                                                                                                D                          D1B APR    01986010119900101        N                           
E0315001003BED ACCESSORY: BOARD, TABLE, OR SUPPORT DEVICE, ANY TYPE                        Bed accessory brd/tbl/supprt00      960-9                                                                                                 M                          D1B APR    01986010119970101        N                           
E0316001003SAFETY ENCLOSURE FRAME/CANOPY FOR USE WITH HOSPITAL BED, ANY TYPE               Bed safety enclosure        36      A                                                                                                     C                          D1B APR    02002010120020101        N                           
E0325001003URINAL; MALE, JUG-TYPE, ANY MATERIAL                                            Urinal male jug-type        32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0326001003URINAL; FEMALE, JUG-TYPE, ANY MATERIAL                                          Urinal female jug-type      32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0350001003CONTROL UNIT FOR ELECTRONIC BOWEL IRRIGATION/EVACUATION SYSTEM                  Control unit bowel system   57      A                                                                                                     C                          Z2  9      01995010119950101        N                           
E0352001003DISPOSABLE PACK (WATER RESERVOIR BAG, SPECULUM, VALVING MECHANISM AND           Disposable pack w/bowel syst57      A                                                                                                     C                          Z2  9      01995010119950101        N                           
E0352002004COLLECTION BAG/BOX) FOR USE WITH THE ELECTRONIC BOWEL IRRIGATION/EVACUATION                                                                                                                                                                                                                                          
E0352003004SYSTEM                                                                                                                                                                                                                                                                                                               
E0370001003AIR PRESSURE  ELEVATOR FOR HEEL                                                 Air elevator for heel       00      9                                                                                                     C                          D1E APR    01997010119980101        N                           
E0371001003NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS   Nonpower mattress overlay   36      A                                                                                                     C                          D1E APR    01998010119980101        N                           
E0371002004LENGTH AND WIDTH                                                                                                                                                                                                                                                                                                     
E0372001003POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH            Powered air mattress overlay36      A                                                                                                     C                          D1E APR    01998010119980101        N                           
E0373001003NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS                                  Nonpowered pressure mattress36      A                                                                                                     C                          D1E APR    01998010119980101        N                           
E0424001003STATIONARY COMPRESSED GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER,        Stationary compressed gas 0233      A60-4              4107.9                                                                             D                          D1C R      01993010120010101        N                           
E0424002004CONTENTS, REGULATOR, FLOWMETER, HUMIDIFIER, NEBULIZER, CANNULA OR MASK, AND                                                                                                                                                                                                                                          
E0424003004TUBING                                                                                                                                                                                                                                                                                                               
E0425001003STATIONARY COMPRESSED GAS SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER,      Gas system stationary compre00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N                           
E0425002004HUMIDIFIER, NEBULIZER, CANNULA OR MASK, AND TUBING                                                                                                                                                                                                                                                                   
E0430001003PORTABLE GASEOUS OXYGEN SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER,        Oxygen system gas portable  00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N                           
E0430002004HUMIDIFIER, CANNULA OR MASK, AND TUBING                                                                                                                                                                                                                                                                              
E0431001003PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, Portable gaseous 02         33      A60-4              4107.9                                                                             D                          D1C R      01993010120010101        N                           
E0431002004FLOWMETER, HUMIDIFIER, CANNULA OR MASK, AND TUBING                                                                                                                                                                                                                                                                   
E0434001003PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, SUPPLY      Portable liquid 02          33      A60-4              4107.9                                                                             D                          D1C R      01993010119930101        N                           
E0434002004RESERVOIR, HUMIDIFIER, FLOWMETER, REFILL ADAPTOR, CONTENTS GAUGE, CANNULA OR                                                                                                                                                                                                                                         
E0434003004MASK, AND TUBING                                                                                                                                                                                                                                                                                                     
E0435001003PORTABLE LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES PORTABLE CONTAINER, SUPPLY    Oxygen system liquid portabl00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N                           
E0435002004RESERVOIR, FLOWMETER, HUMIDIFIER, CONTENTS GAUGE, CANNULA OR MASK, TUBING AND                                                                                                                                                                                                                                        
E0435003004REFILL ADAPTOR                                                                                                                                                                                                                                                                                                       
E0439001003STATIONARY LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER, CONTENTS,          Stationary liquid 02        33      A60-4              4107.9                                                                             D                          D1C R      01993010120010101        N                           
E0439002004REGULATOR, FLOWMETER, HUMIDIFIER, NEBULIZER, CANNULA OR MASK, & TUBING                                                                                                                                                                                                                                               
E0440001003STATIONARY LIQUID OXYGEN SYSTEM, PURCHASE; INCLUDES USE OF RESERVOIR, CONTENTS  Oxygen system liquid station00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N                           
E0440002004INDICATOR, REGULATOR, FLOWMETER, HUMIDIFIER, NEBULIZER, CANNULA OR MASK, AND                                                                                                                                                                                                                                         
E0440003004TUBING                                                                                                                                                                                                                                                                                                               
E0441001003OXYGEN CONTENTS, GASEOUS (FOR USE WITH OWNED GASEOUS STATIONARY SYSTEMS OR WHEN Oxygen contents, gaseous    33      A60-4              4107.9                                                                             D                          D1C P      01993010120030101        N                           
E0441002004BOTH A STATIONARY AND PORTABLE GASEOUS SYSTEM ARE OWNED), 1 MONTH'S SUPPLY = 1                                                                                                                                                                                                                                       
E0441003004UNIT                                                                                                                                                                                                                                                                                                                 
E0442001003OXYGEN CONTENTS, LIQUID (FOR USE WITH OWNED LIQUID STATIONARY SYSTEMS OR WHEN   Oxygen contents, liquid     33      A60-4              4107.9                                                                             D                          D1C P      01993010120030101        N                           
E0442002004BOTH A STATIONARY AND PORTABLE LIQUID SYSTEM ARE OWNED), 1 MONTH'S SUPPLY = 1                                                                                                                                                                                                                                        
E0442003004UNIT                                                                                                                                                                                                                                                                                                                 
E0443001003PORTABLE OXYGEN CONTENTS, GASEOUS (FOR USE ONLY WITH PORTABLE GASEOUS SYSTEMS   Portable 02 contents, gas   33      A60-4              4107.9                                                                             D                          D1C P      01993010120030101        N                           
E0443002004WHEN NO STATIONARY GAS OR LIQUID SYSTEM IS USED), 1 MONTH'S SUPPLY = 1 UNIT                                                                                                                                                                                                                                          
E0444001003PORTABLE OXYGEN CONTENTS, LIQUID (FOR USE ONLY WITH PORTABLE LIQUID SYSTEMS     Portable 02 contents, liquid33      A60-4              4107.9                                                                             D                          D1C P      01993010120030101        N                           
E0444002004WHEN NO STATIONARY GAS OR LIQUID SYSTEM IS USED), 1 MONTH'S SUPPLY = 1 UNIT                                                                                                                                                                                                                                          
E0445001003OXIMETER DEVICE FOR MEASURING BLOOD OXYGEN LEVELS NON-INVASIVELY                Oximeter non-invasive       00      9                                                                                                     C                          Z2  9      02003010120030101        N                           
E0450001003VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE  Vol control vent invasiv int31      A60-9                                                                                                 D                          D1E R      01985010120050101        N                           
E0450002004CONTROL MODE, USED WITH INVASIVE INTERFACE (E.G., TRACHEOSTOMY TUBE)                                                                                                                                                                                                                                                 
E0454001003PRESSURE VENTILATOR WITH PRESSURE CONTROL, PRESSURE SUPPORT AND FLOW TRIGGERING Pressure ventilator         31      A60-9                                                                                                 D                          D1E R      0200301012005010120041231N                           
E0454002004FEATURES                                                                                                                                                                                                                                                                                                             
E0455001003OXYGEN TENT, EXCLUDING CROUP OR PEDIATRIC TENTS                                 Oxygen tent excl croup/ped t33      A60-4              4107.9                                                                             D                          D1C R      01986010119900101        N                           
E0457001003CHEST SHELL (CUIRASS)                                                           Chest shell                 32      A                                                                                                     C                          D1E APR    01990010120010101        N                           
E0459001003CHEST WRAP                                                                      Chest wrap                  36      A                                                                                                     C                          D1E R      01990010119960101        N                           
E0460001003NEGATIVE PRESSURE VENTILATOR;  PORTABLE OR STATIONARY                           Neg press vent portabl/statn31      A60-9                                                                                                 D                          D1E R      01990010119960101        N                           
E0461001003VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE  Vol control vent noninv int 31      A60-9                                                                                                 D                          D1E R      02003010120050101        N                           
E0461002004CONTROL MODE,  USED WITH NON-INVASIVE INTERFACE (E.G. MASK)                                                                                                                                                                                                                                                          
E0462001003ROCKING BED WITH OR WITHOUT SIDE RAILS                                          Rocking bed w/ or w/o side r36      A                                                                                                     C                          D1B R      01990010119960101        N                           
E0463001003PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE      Press supp vent invasive int31      A                                                                                                     C                          D1E R      02005010120050101        P                           
E0463002004CONTROL MODE, USED WITH INVASIVE INTERFACE (E.G. TRACHEOSTOMY TUBE)                                                                                                                                                                                                                                                  
E0464001003PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE      Press supp vent noninv int  31      A                                                                                                     C                          D1E R      02005010120050101        P                           
E0464002004CONTROL MODE, USED WITH NON-INVASIVE INTERFACE (E.G. MASK)                                                                                                                                                                                                                                                           
E0470001003RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE    RAD w/o backup non-inv intfc36      A60-9                                                                                                 D                          D1E R      02004010120040101        N                           
E0470002004FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK                                                                                                                                                                                                                                                 
E0470003004(INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                         
E0471001003RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE      RAD w/backup non inv intrfc 31      A60-9                                                                                                 D                          D1E R      02004010120040101        N                           
E0471002004FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK                                                                                                                                                                                                                                                 
E0471003004(INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                         
E0472001003RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACKUP RATE       RAD w backup invasive intrfc31      A60-9                                                                                                 D                          D1E R      02004010120040101        N                           
E0472002004FEATURE, USED WITH INVASIVE INTERFACE, E.G., TRACHEOSTOMY TUBE (INTERMITTENT                                                                                                                                                                                                                                         
E0472003004ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                                       
E0480001003PERCUSSOR, ELECTRIC OR PNEUMATIC, HOME MODEL                                    Percussor elect/pneum home m36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0481001003INTRAPULMONARY PERCUSSIVE VENTILATION SYSTEM AND RELATED ACCESSORIES            Intrpulmnry percuss vent sys00      960-21                                                                                                M                          D1E APR    02002010120020701        N                           
E0482001003COUGH STIMULATING DEVICE, ALTERNATING POSITIVE AND NEGATIVE AIRWAY PRESSURE     Cough stimulating device    36      A                                                                                                     C                          D1E R      02002010120020101        N                           
E0483001003HIGH FREQUENCY CHEST WALL OSCILLATION AIR-PULSE GENERATOR SYSTEM, (INCLUDES     Chest compression gen system36      A                                                                                                     C                          D1E R      02003010120030101        N                           
E0483002004HOSES AND VEST), EACH                                                                                                                                                                                                                                                                                                
E0484001003OSCILLATORY POSITIVE EXPIRATORY PRESSURE DEVICE, NON-ELECTRIC, ANY TYPE, EACH   Non-elec oscillatory pep dvc32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0485001003ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR Oral device/appliance prefab32      A                                                                                                     C                          D1E P      02006010120060101        A                           
E0485002004NON-ADJUSTABLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
E0486001003ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR Oral device/appliance cusfab32      A                                                                                                     C                          D1E P      02006010120060101        A                           
E0486002004NON-ADJUSTABLE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                   
E0500001003IPPB MACHINE,  ALL TYPES, WITH BUILT-IN NEBULIZATION; MANUAL OR AUTOMATIC       Ippb all types              31      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0500002004VALVES; INTERNAL OR EXTERNAL POWER SOURCE                                                                                                                                                                                                                                                                            
E0550001003HUMIDIFIER, DURABLE FOR EXTENSIVE SUPPLEMENTAL HUMIDIFICATION DURING IPPB       Humidif extens supple w ippb33      A60-9                                                                                                 D                          D1E R      01986010120050701        P                           
E0550002004TREATMENTS OR OXYGEN DELIVERY                                                                                                                                                                                                                                                                                        
E0555001003HUMIDIFIER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC BOTTLE TYPE, FOR USE WITH    Humidifier for use w/ regula33      A60-9              4107.9                                                                             D                          D1C PR     01986010119960101        N                           
E0555002004REGULATOR OR FLOWMETER                                                                                                                                                                                                                                                                                               
E0560001003HUMIDIFIER, DURABLE FOR SUPPLEMENTAL HUMIDIFICATION DURING IPPB TREATMENT OR    Humidifier supplemental w/ i33      A60-9                                                                                                 D                          D1E APR    01986010120050701        P                           
E0560002004OXYGEN DELIVERY                                                                                                                                                                                                                                                                                                      
E0561001003HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE               Humidifier nonheated w PAP  32      A                                                                                                     C                          D1E APR    02004010120040101        N                           
E0562001003HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE                   Humidifier heated used w PAP32      A                                                                                                     C                          D1E APR    02004010120040101        N                           
E0565001003COMPRESSOR, AIR POWER SOURCE FOR EQUIPMENT WHICH IS NOT SELF- CONTAINED OR      Compressor air power source 36      A                                                                                                     C                          D1E R      01982010119960101        N                           
E0565002004CYLINDER DRIVEN                                                                                                                                                                                                                                                                                                      
E0570001003NEBULIZER, WITH COMPRESSOR                                                      Nebulizer with compression  36      A60-9              4107.9                                                                             D                          D1E R      01986010119960101        N                           
E0571001003AEROSOL COMPRESSOR, BATTERY POWERED, FOR USE WITH SMALL VOLUME NEBULIZER        Aerosol compressor for svneb36      A60-9                                                                                                 D                          D1E APR    02001010120010101        N                           
E0572001003AEROSOL COMPRESSOR, ADJUSTABLE PRESSURE, LIGHT DUTY FOR INTERMITTENT USE        Aerosol compressor adjust pr36      A                                                                                                     C                          D1E APR    02001010120010101        N                           
E0574001003ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER             Ultrasonic generator w svneb36      A                                                                                                     C                          D1E APR    02001010120030101        N                           
E0575001003NEBULIZER, ULTRASONIC, LARGE VOLUME                                             Nebulizer ultrasonic        31      A60-9                                                                                                 D                          D1E R      01986010120010101        N                           
E0580001003NEBULIZER, DURABLE, GLASS OR AUTOCLAVABLE PLASTIC, BOTTLE TYPE, FOR USE WITH    Nebulizer for use w/ regulat32      A60-9              4107.9                                                                             D                          D1E PR     01986010119980101        N                           
E0580002004REGULATOR OR FLOWMETER                                                                                                                                                                                                                                                                                               
E0585001003NEBULIZER, WITH COMPRESSOR AND HEATER                                           Nebulizer w/ compressor & he36      A60-9              4107.9                                                                             D                          D1E R      01986010119960101        N                           
E0590001003DISPENSING FEE COVERED DRUG ADMINISTERED THROUGH DME NEBULIZER                  Dispensing fee dme neb drug 46      A                                                                                                     C                          D1G 9      02000010120020701        N                           
E0600001003RESPIRATORY SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC          Suction pump portab hom modl36      A60-9                                                                                                 D                          D1E R      01986010120020101        N                           
E0601001003CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE                                        Cont airway pressure device 36      A60-17                                                                                                D                          D1E R      01988010119960101        N                           
E0602001003BREAST PUMP, MANUAL, ANY TYPE                                                   Manual breast pump          32      A                                                                                                     C                          D1E 9      02000010120020101        N                           
E0603001003BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE                                  Electric breast pump        00      9                                                                                                     C                          Z2  9      02002010120020101        N                           
E0604001003BREAST PUMP, HEAVY DUTY, HOSPITAL GRADE, PISTON OPERATED, PULSATILE VACUUM      Hosp grade elec breast pump 00      9                                                                                                     C                          Z2  9      02002010120020101        N                           
E0604002004SUCTION/RELEASE CYCLES, VACUUM REGULATOR, SUPPLIES, TRANSFORMER, ELECTRIC (AC                                                                                                                                                                                                                                        
E0604003004AND / OR DC)                                                                                                                                                                                                                                                                                                         
E0605001003VAPORIZER, ROOM TYPE                                                            Vaporizer room type         32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0606001003POSTURAL DRAINAGE BOARD                                                         Drainage board postural     36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0607001003HOME BLOOD GLUCOSE MONITOR                                                      Blood glucose monitor home  32      A60-11                                                                                                D                          D1E APR    01986010119960101        N                           
E0608001003APNEA MONITOR                                                                   Apnea monitor               36      A60-17                                                                       E0618                    D                          D1E R      0198601012003010120021231N                           
E0610001003PACEMAKER MONITOR, SELF-CONTAINED, (CHECKS BATTERY DEPLETION, INCLUDES AUDIBLE  Pacemaker monitr audible/vis32      A60-7  50-1                                                                                           D                          D1E APR    01986010119960101        N                           
E0610002004AND VISIBLE CHECK SYSTEMS)                                                                                                                                                                                                                                                                                           
E0615001003PACEMAKER MONITOR, SELF CONTAINED, CHECKS BATTERY DEPLETION AND OTHER PACEMAKER Pacemaker monitr digital/vis32      A60-7  50-1                                                                                           D                          D1E APR    01986010119960101        N                           
E0615002004COMPONENTS, INCLUDES DIGITAL/VISIBLE CHECK SYSTEMS                                                                                                                                                                                                                                                                   
E0616001003IMPLANTABLE CARDIAC EVENT RECORDER WITH MEMORY, ACTIVATOR AND PROGRAMMER        Cardiac event recorder      00      9                                                                                                     C                          D1E 9      02000010120050401        P                           
E0617001003EXTERNAL DEFIBRILLATOR WITH INTEGRATED ELECTROCARDIOGRAM ANALYSIS               Automatic ext defibrillator 36      A                                                                                                     C                          D1E 9R     02001010120010101        N                           
E0618001003APNEA MONITOR, WITHOUT RECORDING FEATURE                                        Apnea monitor               00      9                                                                                                     C                          D1E R      02003010120030101        N                           
E0619001003APNEA MONITOR, WITH RECORDING FEATURE                                           Apnea monitor w recorder    00      9                                                                                                     C                          D1E R      02003010120030101        N                           
E0620001003SKIN PIERCING DEVICE FOR COLLECTION OF CAPILLARY BLOOD, LASER, EACH             Cap bld skin piercing laser 32      A                                                                                                     C                          D1E APR    02002010120020101        N                           
E0621001003SLING OR SEAT, PATIENT LIFT, CANVAS OR NYLON                                    Patient lift sling or seat  32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0625001003PATIENT LIFT, BATHROOM OR TOILET, NOT OTHERWISE CLASSIFIED                      Patient lift bathroom or toi00      960-9                                                                                                 M                          D1E APR    01986010120050101        N                           
E0627001003SEAT LIFT MECHANISM INCORPORATED INTO A COMBINATION LIFT-CHAIR MECHANISM        Seat lift incorp lift-chair 32      A60-8              4107.8                                                    Q0080                    D                          D1E APR    01992010119960101        N                           
E0628001003SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-ELECTRIC      Seat lift for pt furn-electr32      A60-8              4107.8                                                    Q0078                    D                          D1E APR    01992010119960101        N                           
E0629001003SEPARATE SEAT LIFT MECHANISM FOR USE WITH PATIENT OWNED FURNITURE-NON-ELECTRIC  Seat lift for pt furn-non-el32      A                  4107.8                                                    Q0079                    D                          D1E APR    01992010119960101        N                           
E0630001003PATIENT LIFT, HYDRAULIC, WITH SEAT OR SLING                                     Patient lift hydraulic      36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0635001003PATIENT LIFT, ELECTRIC WITH SEAT OR SLING                                       Patient lift electric       36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0636001003MULTIPOSITIONAL PATIENT SUPPORT SYSTEM, WITH INTEGRATED LIFT, PATIENT           PT support & positioning sys36      A                                                                                                     C                          D1E R      02003010120030101        N                           
E0636002004ACCESSIBLE CONTROLS                                                                                                                                                                                                                                                                                                  
E0637001003COMBINATION SIT TO STAND SYSTEM, ANY SIZE INCLUDING PEDIATRIC, WITH SEATLIFT    Combination sit to stand sys32      A60-9                                                                                                 D                          D1E APR    02004010120060101        C                           
E0637002004FEATURE, WITH OR WITHOUT WHEELS                                                                                                                                                                                                                                                                                      
E0638001003STANDING FRAME SYSTEM, ONE POSITION (E.G. UPRIGHT, SUPINE OR PRONE STANDER),    Standing frame sys          00      960-9                                                                                                 M                          D1E APR    02004010120060101        C                           
E0638002004ANY SIZE INCLUDING PEDIATRIC, WITH OR WITHOUT WHEELS                                                                                                                                                                                                                                                                 
E0639001003PATIENT LIFT, MOVEABLE FROM ROOM TO ROOM WITH DISASSEMBLY AND REASSEMBLY,       Moveable patient lift system00      9                                                                                                     I                          Y2  9      02005010120050101        N                           
E0639002004INCLUDES ALL COMPONENTS/ACCESSORIES                                                                                                                                                                                                                                                                                  
E0640001003PATIENT LIFT, FIXED SYSTEM, INCLUDES ALL COMPONENTS/ACCESSORIES                 Fixed patient lift system   00      9                                                                                                     I                          Y2  9      02005010120050101        N                           
E0641001003STANDING FRAME SYSTEM, MULTI-POSITION (E.G. THREE-WAY STANDER), ANY SIZE        Multi-position stnd fram sys00      960-9                                                                                                 M                          D1E APR    02006010120060101        A                           
E0641002004INCLUDING PEDIATRIC, WITH OR WITHOUT WHEELS                                                                                                                                                                                                                                                                          
E0642001003STANDING FRAME SYSTEM, MOBILE (DYNAMIC STANDER), ANY SIZE INCLUDING PEDIATRIC   Dynamic standing frame      00      960-9                                                                                                 M                          D1E APR    02006010120060101        A                           
E0650001003PNEUMATIC COMPRESSOR, NON-SEGMENTAL HOME MODEL                                  Pneuma compresor non-segment32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0651001003PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITHOUT CALIBRATED GRADIENT PRESSURE Pneum compressor segmental  32      A60-16                                                                                                D                          D1E APR    01988010119960101        N                           
E0652001003PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITH CALIBRATED GRADIENT PRESSURE    Pneum compres w/cal pressure32      A60-16                                                                                                D                          D1E APR    01988010119960101        N                           
E0655001003NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF ARM   Pneumatic appliance half arm32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0660001003NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG   Pneumatic appliance full leg32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0665001003NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM   Pneumatic appliance full arm32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0666001003NON-SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG   Pneumatic appliance half leg32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0667001003SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL LEG       Seg pneumatic appl full leg 32      A60-16                                                                                                D                          D1E APR    01988010119960101        N                           
E0668001003SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, FULL ARM       Seg pneumatic appl full arm 32      A60-16                                                                                                D                          D1E APR    01988010119960101        N                           
E0669001003SEGMENTAL PNEUMATIC APPLIANCE FOR USE WITH PNEUMATIC COMPRESSOR, HALF LEG       Seg pneumatic appli half leg32      A60-16                                                                                                D                          D1E APR    01994010119940101        N                           
E0671001003SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL LEG                       Pressure pneum appl full leg32      A60-16                                                                                                D                          D1E APR    01995010119950101        N                           
E0672001003SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL ARM                       Pressure pneum appl full arm32      A60-16                                                                                                D                          D1E APR    01995010119950101        N                           
E0673001003SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, HALF LEG                       Pressure pneum appl half leg32      A60-16                                                                                                D                          D1E APR    01995010119950101        N                           
E0675001003PNEUMATIC COMPRESSION DEVICE, HIGH PRESSURE, RAPID INFLATION/DEFLATION CYCLE,   Pneumatic compression device36      A                                                                                                     C                          D1E R      02004010120040101        N                           
E0675002004FOR ARTERIAL INSUFFICIENCY (UNILATERAL OR BILATERAL SYSTEM)                                                                                                                                                                                                                                                          
E0690001003ULTRAVIOLET CABINET, APPROPRIATE FOR HOME USE                                   Ultraviolet cabinet         32      A60-9                                                                                                 D                          D1E APR    0198601012003010120021231N                           
E0691001003ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE     Uvl pnl 2 sq ft or less     32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0691002004PROTECTION; TREATMENT AREA 2 SQUARE FEET OR LESS                                                                                                                                                                                                                                                                     
E0692001003ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE     Uvl sys panel 4 ft          32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0692002004PROTECTION, 4 FOOT PANEL                                                                                                                                                                                                                                                                                             
E0693001003ULTRAVIOLET LIGHT THERAPY SYSTEM PANEL, INCLUDES BULBS/LAMPS, TIMER AND EYE     Uvl sys panel 6 ft          32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0693002004PROTECTION, 6 FOOT PANEL                                                                                                                                                                                                                                                                                             
E0694001003ULTRAVIOLET MULTIDIRECTIONAL LIGHT THERAPY SYSTEM IN 6 FOOT CABINET, INCLUDES   Uvl md cabinet sys 6 ft     32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0694002004BULBS/LAMPS, TIMER AND EYE PROTECTION                                                                                                                                                                                                                                                                                
E0700001003SAFETY EQUIPMENT (E.G., BELT, HARNESS OR VEST)                                  Safety equipment            00      9                                                                                                     C                          D1E APR    01986010119960101        N                           
E0701001003HELMET WITH FACE GUARD AND SOFT INTERFACE MATERIAL, PREFABRICATED               Helmet w face guard prefab  32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0705001003TRANSFER BOARD OR DEVICE, ANY TYPE, EACH                                        Transfer board or device    00      9                                                                                                     D                      0125Z2  APR    02006010120060101        A                           
E0710001003RESTRAINTS, ANY TYPE (BODY, CHEST, WRIST OR ANKLE)                              Restraints any type         57      A                                                                                                     C                          Z2  APR    01986010119960101        N                           
E0720001003TENS, TWO LEAD, LOCALIZED STIMULATION                                           Tens two lead               32      A35-20 35-46       4107.6                                                                             D                          D1E APR    01986010119960101        N                           
E0730001003TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION DEVICE, FOUR OR MORE LEADS, FOR     Tens four lead              32      A35-20 35-46       4107.6                                                                             D                          D1E APR    01986010120030101        N                           
E0730002004MULTIPLE NERVE STIMULATION                                                                                                                                                                                                                                                                                           
E0731001003FORM FITTING CONDUCTIVE GARMENT FOR DELIVERY OF TENS OR NMES (WITH CONDUCTIVE   Conductive garment for tens/34      A45-25                                                                                                D                          D1E APR    01989010119960101        N                           
E0731002004FIBERS SEPARATED FROM THE PATIENT'S SKIN BY LAYERS OF FABRIC)                                                                                                                                                                                                                                                        
E0740001003INCONTINENCE TREATMENT SYSTEM, PELVIC FLOOR STIMULATOR, MONITOR, SENSOR AND/OR  Incontinence treatment systm32      A60.24                                                                                                D                          D1E APR    01986010120010401        N                           
E0740002004TRAINER                                                                                                                                                                                                                                                                                                              
E0744001003NEUROMUSCULAR STIMULATOR FOR SCOLIOSIS                                          Neuromuscular stim for scoli36      A                                                                                                     C                          D1E R      01989010119960101        N                           
E0745001003NEUROMUSCULAR STIMULATOR, ELECTRONIC SHOCK UNIT                                 Neuromuscular stim for shock36      A35-77                                                                                                D                          D1E R      01986010119960101        N                           
E0746001003ELECTROMYOGRAPHY (EMG), BIOFEEDBACK DEVICE                                      Electromyograph biofeedback 52      A35-27                                                                                                D                          D1E APR    01989010119960101        N                           
E0747001003OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, OTHER THAN SPINAL            Elec osteogen stim not spine32      A35-48                                                                                                D                          D1E APR    01986010119970101        N                           
E0747002004APPLICATIONS                                                                                                                                                                                                                                                                                                         
E0748001003OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, SPINAL APPLICATIONS          Elec osteogen stim spinal   32      A35-48                                                                                                D                          D1E APR    01996010119970101        N                           
E0749001003OSTEOGENESIS STIMULATOR, ELECTRICAL, SURGICALLY IMPLANTED                       Elec osteogen stim implanted36      A35-48                                                                                                D                          D1E 9      01986010120000701        N                           
E0752001003IMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH                                     Neurostimulator electrode   38      A                  65-8                                                      L8680                    D                          D1F P      0200201012006010120051231D                           
E0754001003PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE             Pulsegenerator pt programmer38      A65-8                                                                        L8681                    D                          D1F P      0200201012006010120051231D                           
E0754002004NEUROSTIMULATOR PULSE GENERATOR                                                                                                                                                                                                                                                                                      
E0755001003ELECTRONIC SALIVARY REFLEX STIMULATOR (INTRA-ORAL/NON-INVASIVE)                 Electronic salivary reflex s52      A                                                                                                     C                          Z2  APR    01990010119950401        N                           
E0756001003IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR                                     Implantable pulse generator 38      A65-8                                                                                                 D                          D1F P      0200101012006010120051231D                           
E0757001003IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER                             Implantable RF receiver     38      A65-8                                                                        L8682                    D                          D1F P      0200101012006010120051231D                           
E0758001003RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR  External RF transmitter     38      A65-8                                                                        L8683                    D                          D1F P      0200101012006010120051231D                           
E0758002004RADIOFREQUENCY RECEIVER                                                                                                                                                                                                                                                                                              
E0759001003RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT      Replace rdfrquncy transmittr38      A                                                                            L8684                    C                          D1F P      0200201012006010120051231D                           
E0759002004NEUROSTIMULATOR RECEIVER FOR BOWEL AND BLADDER MANAGEMENT, REPLACEMENT                                                                                                                                                                                                                                               
E0760001003OSTEOGENESIS STIMULATOR, LOW INTENSITY ULTRASOUND, NON-INVASIVE                 Osteogen ultrasound stimltor32      A                  35-48                                                                              C                          D1E APR    01997010120010101        N                           
E0761001003NON-THERMAL PULSED HIGH FREQUENCY RADIOWAVES, HIGH PEAK POWER ELECTROMAGNETIC   Nontherm electromgntc device00      935-102                                                                                               D                          D1E 9      02003010120050101        F                           
E0761002004ENERGY TREATMENT DEVICE                                                                                                                                                                                                                                                                                              
E0762001003TRANSCUTANEOUS ELECTRICAL JOINT STIMULATION DEVICE SYSTEM, INCLUDES ALL         Trans elec jt stim dev sys  36      A                                                                                                     C                          D1E APR    02006010120060101        A                           
E0762002004ACCESSORIES                                                                                                                                                                                                                                                                                                          
E0764001003FUNCTIONAL NEUROMUSCULAR STIMULATOR, TRANSCUTANEOUS STIMULATION OF MUSCLES OF   Functional neuromuscularstim32      A35-77                                                                                                D                          D1F APR    02006010120060101        A                           
E0764002004AMBULATION WITH COMPUTER CONTROL, USED FOR WALKING BY SPINAL CORD INJURED,                                                                                                                                                                                                                                           
E0764003004ENTIRE SYSTEM, AFTER COMPLETION OF TRAINING PROGRAM                                                                                                                                                                                                                                                                  
E0765001003FDA APPROVED NERVE STIMULATOR, WITH REPLACEABLE BATTERIES, FOR TREATMENT OF     Nerve stimulator for tx n&v 32      A                                                                                                     C                          D1E AP     02001010120010101        N                           
E0765002004NAUSEA AND VOMITING                                                                                                                                                                                                                                                                                                  
E0769001003ELECTRICAL STIMULATION OR ELECTROMAGNETIC WOUND TREATMENT DEVICE, NOT OTHERWISE Electric wound treatment dev00      935-102                                                                                               D                          Y2  9      02005010120050101        N                           
E0769002004CLASSIFIED                                                                                                                                                                                                                                                                                                           
E0776001003IV POLE                                                                         Iv pole                     32      A                                                                                                     C                          D1E AEPR   01985010119950401        N                           
E0779001003AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION 8 HOURS OR GREATER Amb infusion pump mechanical36      A                                                                                                     C                          D1E APR    02000010120000101        N                           
E0780001003AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION LESS THAN 8 HOURS  Mech amb infusion pump <8hrs32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
E0781001003AMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE CHANNELS, ELECTRIC OR BATTERY      External ambulatory infus pu36      A60-14                                                                                                D                          D1E 9R     01987010120000701        N                           
E0781002004OPERATED, WITH ADMINISTRATIVE EQUIPMENT, WORN BY PATIENT                                                                                                                                                                                                                                                             
E0782001003INFUSION PUMP, IMPLANTABLE, NON-PROGRAMMABLE (INCLUDES ALL COMPONENTS, E.G.,    Non-programble infusion pump32      A60-14                                                                                                D                          D1E APR    01986010120030101        N                           
E0782002004PUMP, CATHETER, CONNECTORS, ETC.)                                                                                                                                                                                                                                                                                    
E0783001003INFUSION PUMP SYSTEM, IMPLANTABLE, PROGRAMMABLE (INCLUDES ALL COMPONENTS, E.G., Programmable infusion pump  32      A60-14                                                                                                D                          D1E APR    01995010119980101        N                           
E0783002004PUMP, CATHETER, CONNECTORS, ETC.)                                                                                                                                                                                                                                                                                    
E0784001003EXTERNAL AMBULATORY INFUSION PUMP, INSULIN                                      Ext amb infusn pump insulin 36      A60-14                                                                                                D                          D1E R      01996010120000701        N                           
E0785001003IMPLANTABLE INTRASPINAL (EPIDURAL/INTRATHECAL) CATHETER USED WITH IMPLANTABLE   Replacement impl pump cathet32      A                  60-14                                                                              D                          D1E P      01999010119990101        N                           
E0785002004INFUSION PUMP, REPLACEMENT                                                                                                                                                                                                                                                                                           
E0786001003IMPLANTABLE PROGRAMMABLE INFUSION PUMP, REPLACEMENT (EXCLUDES IMPLANTABLE       Implantable pump replacement32      A60-14                                                                                                D                          D1E 9      02001010120010101        N                           
E0786002004INTRASPINAL CATHETER)                                                                                                                                                                                                                                                                                                
E0791001003PARENTERAL INFUSION PUMP, STATIONARY, SINGLE OR MULTI-CHANNEL                   Parenteral infusion pump sta36      A65-10             2130    4450                                                                       D                          D1E R      01989010119960101        N                           
E0830001003AMBULATORY TRACTION DEVICE, ALL TYPES, EACH                                     Ambulatory traction device  00      960-9                                                                                                 D                          D1E P      02001010120010101        N                           
E0840001003TRACTION FRAME, ATTACHED TO HEADBOARD, CERVICAL TRACTION                        Tract frame attach headboard32      A60-9                                                                                                 D                          D1E APR    01984010119940101        N                           
E0849001003TRACTION EQUIPMENT, CERVICAL, FREE-STANDING STAND/FRAME, PNEUMATIC, APPLYING    Cervical pneum trac equip   32      A                                                                                                     C                          D1E APR    02005010120050101        N                           
E0849002004TRACTION FORCE TO OTHER THAN MANDIBLE                                                                                                                                                                                                                                                                                
E0850001003TRACTION STAND, FREE STANDING, CERVICAL TRACTION                                Traction stand free standing32      A60-9                                                                                                 D                          D1E APR    01982010119940101        N                           
E0855001003CERVICAL TRACTION EQUIPMENT NOT REQUIRING ADDITIONAL STAND OR FRAME             Cervical traction equipment 32      A                                                                                                     C                          D1E APR    01998010119980101        N                           
E0860001003TRACTION EQUIPMENT, OVERDOOR, CERVICAL                                          Tract equip cervical tract  32      A60-9                                                                                                 D                          D1E APR    01986010119890101        N                           
E0870001003TRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY TRACTION, (E.G. BUCK'S)        Tract frame attach footboard32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N                           
E0880001003TRACTION STAND, FREE STANDING, EXTREMITY TRACTION, (E.G., BUCK'S)               Trac stand free stand extrem32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N                           
E0890001003TRACTION FRAME, ATTACHED TO FOOTBOARD, PELVIC TRACTION                          Traction frame attach pelvic32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N                           
E0900001003TRACTION STAND, FREE STANDING, PELVIC TRACTION, (E.G., BUCK'S)                  Trac stand free stand pelvic32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N                           
E0910001003TRAPEZE BARS, A/K/A PATIENT HELPER, ATTACHED TO BED, WITH GRAB BAR              Trapeze bar attached to bed 36      A60-9                                                                                                 D                          D1E R      01986010119840101        N                           
E0911001003TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS,   HD trapeze bar attach to bed36      A60-9                                                                                                 D                          D1B R      02006010120060101        A                           
E0911002004ATTACHED TO BED, WITH GRAB BAR                                                                                                                                                                                                                                                                                       
E0912001003TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS,   HD trapeze bar free standing36      A60-9                                                                                                 D                          D1B R      02006010120060101        A                           
E0912002004FREE STANDING, COMPLETE WITH GRAB BAR                                                                                                                                                                                                                                                                                
E0920001003FRACTURE FRAME, ATTACHED TO BED, INCLUDES WEIGHTS                               Fracture frame attached to b36      A60-9                                                                                                 D                          D1E R      01986010119890101        N                           
E0930001003FRACTURE FRAME, FREE STANDING, INCLUDES WEIGHTS                                 Fracture frame free standing36      A60-9                                                                                                 D                          D1E R      01986010119890101        N                           
E0935001003CONTINUOUS PASSIVE MOTION EXERCISE DEVICE FOR USE ON KNEE ONLY                  Cont pas motion exercise dev31      A60-9                                                                                                 D                          D1E R      01986010120060101        C                           
E0940001003TRAPEZE BAR, FREE STANDING, COMPLETE WITH GRAB BAR                              Trapeze bar free standing   36      A60-9                                                                                                 D                          D1B R      01986010119890101        N                           
E0941001003GRAVITY ASSISTED TRACTION DEVICE, ANY TYPE                                      Gravity assisted traction de36      A60-9                                                                                                 D                          D1E R      01986010119890101        N                           
E0942001003CERVICAL HEAD HARNESS/HALTER                                                    Cervical head harness/halter32      A                                                                                                     C                          D1E APR    01986010119860101        N                           
E0943001003CERVICAL PILLOW                                                                 Cervical pillow             32      A                                                                                                     C                          D1E APR    0198601012004010120031231N                           
E0944001003PELVIC BELT/HARNESS/BOOT                                                        Pelvic belt/harness/boot    32      A                                                                                                     C                          D1E APR    01985010119960101        N                           
E0945001003EXTREMITY BELT/HARNESS                                                          Belt/harness extremity      32      A                                                                                                     C                          D1E APR    01985010119960101        N                           
E0946001003FRACTURE, FRAME, DUAL WITH CROSS BARS, ATTACHED TO BED, (E.G. BALKEN, 4 POSTER) Fracture frame dual w cross 36      A60-9                                                                                                 D                          D1E R      01986010119890101        N                           
E0947001003FRACTURE FRAME, ATTACHMENTS FOR COMPLEX PELVIC TRACTION                         Fracture frame attachmnts pe32      A60-9                                                                                                 D                          D1E APR    01986010119890101        N                           
E0948001003FRACTURE FRAME, ATTACHMENTS FOR COMPLEX CERVICAL TRACTION                       Fracture frame attachmnts ce32      A60-9                                                                                                 D                          D1E APR    01986010119890101        N                           
E0950001003WHEELCHAIR ACCESSORY, TRAY, EACH                                                Tray                        00      960-9                                                                                                 D                          D1D APR    01986010120040101        N                           
E0951001003HEEL LOOP/HOLDER, ANY TYPE, WITH OR WITHOUT ANKLE STRAP, EACH                   Loop heel                   00      9                                                                                                     C                          D1D APR    01986010120050101        N                           
E0952001003TOE LOOP/HOLDER, ANY TYPE, EACH                                                 Toe loop/holder, each       00      960-9                                                                                                 D                          D1D APR    01986010120050101        N                           
E0953001003PNEUMATIC TIRE, EACH                                                            Pneumatic tire              00      960-9                                                                        E2211                    I                          D1D APR    0198601012006010120051231D                           
E0954001003SEMI-PNEUMATIC CASTER, EACH                                                     Wheelchair semi-pneumatic ca00      960-9                                                                        E2219                    I                          D1D APR    0198601012006010120051231D                           
E0955001003WHEELCHAIR ACCESSORY, HEADREST, CUSHIONED, ANY TYPE, INCLUDING FIXED MOUNTING   Cushioned headrest          32      A                                                                                                     C                          D1D APR    02004010120050101        N                           
E0955002004HARDWARE, EACH                                                                                                                                                                                                                                                                                                       
E0956001003WHEELCHAIR ACCESSORY, LATERAL TRUNK OR HIP SUPPORT, ANY TYPE, INCLUDING FIXED   W/c lateral trunk/hip suppor32      A                                                                                                     C                          D1D APR    02004010120050101        N                           
E0956002004MOUNTING HARDWARE, EACH                                                                                                                                                                                                                                                                                              
E0957001003WHEELCHAIR ACCESSORY, MEDIAL THIGH SUPPORT, ANY TYPE, INCLUDING FIXED MOUNTING  W/c medial thigh support    32      A                                                                                                     C                          D1D APR    02004010120050101        N                           
E0957002004HARDWARE, EACH                                                                                                                                                                                                                                                                                                       
E0958001003MANUAL WHEELCHAIR ACCESSORY, ONE-ARM DRIVE ATTACHMENT, EACH                     Whlchr att- conv 1 arm drive00      960-9                                                                                                 D                          D1D R      01986010120040101        N                           
E0959001003MANUAL WHEELCHAIR ACCESSORY, ADAPTER FOR AMPUTEE, EACH                          Amputee adapter             00      960-9                                                                                                 C                          D1D APR    01986010120040101        N                           
E0960001003WHEELCHAIR ACCESSORY, SHOULDER HARNESS/STRAPS OR CHEST STRAP, INCLUDING ANY     W/c shoulder harness/straps 32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E0960002004TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                               
E0961001003MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK BRAKE EXTENSION (HANDLE), EACH          Wheelchair brake extension  00      960-9                                                                                                 C                          D1D APR    01986010120040101        N                           
E09620010031" CUSHION, FOR WHEELCHAIR                                                      Wheelchair 1 inch cushion   00      9                                                                                                     I                          D1D APR    0198601012005010120041231N                           
E09630010032" CUSHION, FOR WHEELCHAIR                                                      Wheelchair 2 inch cushion   00      9                                                                                                     I                          D1D APR    0198601012005010120041231N                           
E09640010033" CUSHION, FOR WHEELCHAIR                                                      Wheelchair 3 inch cushion   00      9                                                                                                     I                          D1D APR    0198601012005010120041231N                           
E09650010034" CUSHION, FOR WHEELCHAIR                                                      Wheelchair 4 inch cushion   00      9                                                                                                     I                          D1D APR    0198601012005010120041231N                           
E0966001003MANUAL WHEELCHAIR ACCESSORY, HEADREST EXTENSION, EACH                           Wheelchair head rest extensi00      960-9                                                                                                 C                          D1D APR    01986010120040101        N                           
E0967001003MANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECTIONS, ANY TYPE, REPLACEMENT   Wheelchair hand rims        32      A60-9                                                                                                 D                          D1D APR    01986010120050101        N                           
E0967002004ONLY, EACH                                                                                                                                                                                                                                                                                                           
E0968001003COMMODE SEAT, WHEELCHAIR                                                        Wheelchair commode seat     36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E0969001003NARROWING DEVICE, WHEELCHAIR                                                    Wheelchair narrowing device 32      A60-9                                                                                                 D                          D1D APR    01986010119890101        N                           
E0970001003NO.2 FOOTPLATES, EXCEPT FOR ELEVATING LEG REST                                  Wheelchair no. 2 footplates 00      960-9                                                                        K0037K0042               I                          D1D APR    01986010120010401        N                           
E0971001003MANUAL WHEELCHAIR ACCESSORY, ANTI-TIPPING DEVICE, EACH                          Wheelchair anti-tipping devi00      960-9                                                                        K0021                    C                          D1D APR    01986010120060101        C                           
E0972001003WHEELCHAIR ACCESSORY, TRANSFER BOARD OR DEVICE, EACH                            Transfer board or device    00      9                                                                                                     C                          Z2  APR    0198601012006010120051231D                           
E0973001003WHEELCHAIR ACCESSORY, ADJUSTABLE HEIGHT, DETACHABLE ARMREST, COMPLETE ASSEMBLY, W/Ch access det adj armrest 00      960-9                                                                                                 D                          D1D APR    01986010120040101        N                           
E0973002004EACH                                                                                                                                                                                                                                                                                                                 
E0974001003MANUAL WHEELCHAIR ACCESSORY, ANTI-ROLLBACK DEVICE, EACH                         W/Ch access anti-rollback   00      960-9                                                                                                 D                          D1D APR    01986010120040101        N                           
E0975001003REINFORCED SEAT UPHOLSTERY, WHEELCHAIR                                          Wheelchair reinforced seat u00      960-9                                                                                                 I                          D1D APR    0198601012004010120031231N                           
E0976001003REINFORCED BACK, WHEELCHAIR, UPHOLSTERY OR OTHER MATERIAL                       Wheelchair reinforced back u00      960-9                                                                                                 I                          D1D APR    0198601012004010120031231N                           
E0977001003WEDGE CUSHION, WHEELCHAIR                                                       Wheelchair wedge cushion    32      A                                                                                                     C                          D1D APR    01986010119890101        N                           
E0978001003WHEELCHAIR ACCESSORY,  POSITIONING BELT/SAFETY BELT/PELVIC STRAP, EACH          W/C acc,saf belt pelv strap 00      9                                                                                                     C                          D1D APR    01986010120050101        N                           
E0979001003BELT, SAFETY WITH VELCRO CLOSURE, WHEELCHAIR                                    Wheelchair belt with velcro 00      9                                                                                                     I                          D1D APR    0198601012004010120031231N                           
E0980001003SAFETY VEST, WHEELCHAIR                                                         Wheelchair safety vest      32      A                                                                                                     C                          D1D APR    01986010119890101        N                           
E0981001003WHEELCHAIR ACCESSORY, SEAT UPHOLSTERY, REPLACEMENT ONLY, EACH                   Seat upholstery, replacement32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E0982001003WHEELCHAIR ACCESSORY, BACK UPHOLSTERY, REPLACEMENT ONLY, EACH                   Back upholstery, replacement32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E0983001003MANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVERT MANUAL WHEELCHAIR TO       Add pwr joystick            36      A                                                                                                     C                          D1D R      02004010120040101        N                           
E0983002004MOTORIZED WHEELCHAIR, JOYSTICK CONTROL                                                                                                                                                                                                                                                                               
E0984001003MANUAL WHEELCHAIR ACCESSORY, POWER ADD-ON TO CONVERT MANUAL WHEELCHAIR TO       Add pwr tiller              32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E0984002004MOTORIZED WHEELCHAIR, TILLER CONTROL                                                                                                                                                                                                                                                                                 
E0985001003WHEELCHAIR ACCESSORY, SEAT LIFT MECHANISM                                       W/c seat lift mechanism     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E0986001003MANUAL WHEELCHAIR ACCESSORY, PUSH ACTIVATED POWER ASSIST, EACH                  Man w/c push-rim pow assist 32      A                                                                                                     C                          D1D APR    02004010120050101        N                           
E0990001003WHEELCHAIR ACCESSORY, ELEVATING LEG REST, COMPLETE ASSEMBLY, EACH               Whellchair elevating leg res00      960-9                                                                                                 C                          D1D APR    01986010120040101        N                           
E0991001003UPHOLSTERY SEAT                                                                 Wheelchair upholstry seat   00      960-9                                                                                                 I                          D1D APR    0198601012004010120031231N                           
E0992001003MANUAL WHEELCHAIR ACCESSORY, SOLID SEAT INSERT                                  Wheelchair solid seat insert32      A                                                                                                     C                          D1D APR    01986010120040101        N                           
E0993001003BACK, UPHOLSTERY                                                                Wheelchair back upholstery  00      960-9                                                                                                 I                          D1D APR    0198601012004010120031231N                           
E0994001003ARM REST, EACH                                                                  Wheelchair arm rest         32      A60-9                                                                                                 D                          D1D APR    01986010119890101        N                           
E0995001003WHEELCHAIR ACCESSORY, CALF REST/PAD, EACH                                       Wheelchair calf rest        00      960-9                                                                                                 C                          D1D APR    01986010120040101        N                           
E0996001003TIRE, SOLID, EACH                                                               Wheelchair tire solid       00      960-9                                                                        E2220                    I                          D1D APR    0198601012006010120051231D                           
E0997001003CASTER WITH A FORK                                                              Wheelchair caster w/ a fork 32      A60-9                                                                                                 D                          D1D APR    01986010119890101        N                           
E0998001003CASTER WITHOUT FORK                                                             Wheelchair caster w/o a fork32      A60-9                                                                                                 D                          D1D APR    01986010119890101        N                           
E0999001003PNEUMATIC TIRE WITH WHEEL                                                       Wheelchr pneumatic tire w/wh32      A60-9                                                                                                 D                          D1D APR    01986010119890101        N                           
E1000001003TIRE, PNEUMATIC CASTER                                                          Wheelchair tire pneumatic ca00      960-9                                                                        E2214                    I                          D1D APR    0198601012006010120051231D                           
E1001001003WHEEL, SINGLE                                                                   Wheelchair wheel            32      A60-9                                                                        E2224                    D                          D1D APR    0198601012006010120051231D                           
E1002001003WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, TILT ONLY                           Pwr seat tilt               32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1003001003WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITHOUT SHEAR         Pwr seat recline            32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1003002004REDUCTION                                                                                                                                                                                                                                                                                                            
E1004001003WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITH MECHANICAL SHEAR Pwr seat recline mech       32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1004002004REDUCTION                                                                                                                                                                                                                                                                                                            
E1005001003WHEELCHAIR ACCESSORY, POWER SEATNG SYSTEM, RECLINE ONLY, WITH POWER SHEAR       Pwr seat recline pwr        32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1005002004REDUCTION                                                                                                                                                                                                                                                                                                            
E1006001003WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE,       Pwr seat combo w/o shear    32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1006002004WITHOUT SHEAR REDUCTION                                                                                                                                                                                                                                                                                              
E1007001003WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH  Pwr seat combo w/shear      32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1007002004MECHANICAL SHEAR REDUCTION                                                                                                                                                                                                                                                                                           
E1008001003WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH  Pwr seat combo pwr shear    32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1008002004POWER SHEAR REDUCTION                                                                                                                                                                                                                                                                                                
E1009001003WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, MECHANICALLY LINKED LEG Add mech leg elevation      32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1009002004ELEVATION SYSTEM, INCLUDING PUSHROD AND LEG REST, EACH                                                                                                                                                                                                                                                               
E1010001003WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, POWER LEG ELEVATION     Add pwr leg elevation       32      A                                                                                                     C                          D1D APR    02004010120050101        N                           
E1010002004SYSTEM, INCLUDING LEG REST, PAIR                                                                                                                                                                                                                                                                                     
E1011001003MODIFICATION TO PEDIATRIC SIZE WHEELCHAIR, WIDTH ADJUSTMENT PACKAGE (NOT TO BE  Ped wc modify width adjustm 32      A60-9                                                                                                 D                          D1D APR    02003010120050101        N                           
E1011002004DISPENSED WITH INITIAL CHAIR)                                                                                                                                                                                                                                                                                        
E1012001003INTEGRATED SEATING SYSTEM, PLANAR, FOR PEDIATRIC WHEELCHAIR                     Int seat sys planar ped w/c 32      A60-9                                                                                                 D                          D1D APR    0200301012005010120041231N                           
E1013001003INTEGRATED SEATING SYSTEM, CONTOURED, FOR PEDIATRIC WHEELCHAIR                  Int seat sys contour ped w/c32      A60-9                                                                                                 D                          D1D APR    0200301012005010120041231N                           
E1014001003RECLINING BACK, ADDITION TO PEDIATRIC SIZE WHEELCHAIR                           Reclining back add ped w/c  32      A60-9                                                                                                 D                          D1D APR    02003010120050101        N                           
E1015001003SHOCK ABSORBER FOR MANUAL WHEELCHAIR, EACH                                      Shock absorber for man w/c  32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N                           
E1016001003SHOCK ABSORBER FOR POWER WHEELCHAIR, EACH                                       Shock absorber for power w/c32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N                           
E1017001003HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA HEAVY DUTY MANUAL WHEELCHAIR, HD shck absrbr for hd man wc32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N                           
E1017002004EACH                                                                                                                                                                                                                                                                                                                 
E1018001003HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY OR EXTRA HEAVY DUTY POWER WHEELCHAIR,  HD shck absrber for hd powwc32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N                           
E1018002004EACH                                                                                                                                                                                                                                                                                                                 
E1019001003WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, HEAVY DUTY FEATURE, PATIENT WEIGHT  HD feature power seat       00      9                                                                                                     I                          D1D APR    0200401012006010120051231D                           
E1019002004CAPACITY GREATER THAN 250 POUNDS AND LESS THAN OR EQUAL TO 400 POUNDS                                                                                                                                                                                                                                                
E1020001003RESIDUAL LIMB SUPPORT SYSTEM FOR WHEELCHAIR                                     Residual limb support system32      A                  60-6                                                                               D                          D1D APR    02003010120030101        N                           
E1021001003WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, EXTRA HEAVY DUTY FEATURE, WEIGHT    Ex hd feature power seat    00      9                                                                                                     I                          D1D APR    0200401012006010120051231D                           
E1021002004CAPACITY GREATER THAN 400 POUNDS                                                                                                                                                                                                                                                                                     
E1025001003LATERAL THORACIC SUPPORT, NON-CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH         Pedwc lat/thor sup nocontour00      9                                                                                                     I                          D1D APR    0200301012006010120051231D                           
E1025002004(INCLUDES HARDWARE)                                                                                                                                                                                                                                                                                                  
E1026001003LATERAL THORACIC SUPPORT, CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES   Pedwc contoured lat/thor sup00      9                                                                                                     I                          D1D APR    0200301012006010120051231D                           
E1026002004HARDWARE)                                                                                                                                                                                                                                                                                                            
E1027001003LATERAL/ANTERIOR SUPPORT, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE)    Ped wc lat/ant support      00      9                                                                                                     I                          D1D APR    0200301012006010120051231D                           
E1028001003WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING       W/c manual swingaway        32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1028002004HARDWARE FOR JOYSTICK, OTHER CONTROL INTERFACE OR POSITIONING ACCESSORY                                                                                                                                                                                                                                              
E1029001003WHEELCHAIR ACCESSORY, VENTILATOR TRAY, FIXED                                    W/c vent tray fixed         32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1030001003WHEELCHAIR ACCESSORY, VENTILATOR TRAY, GIMBALED                                 W/c vent tray gimbaled      32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1031001003ROLLABOUT CHAIR, ANY AND ALL TYPES WITH CASTORS 5" OR GREATER                   Rollabout chair with casters36      A60-9                                                                                                 D                          D1D R      01990010119900101        N                           
E1035001003MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, WITH INTEGRATED SEAT, OPERATED BY     Patient transfer system     36      A                  2100                                                                               D                          D1D R      02001010120030101        N                           
E1035002004CARE GIVER                                                                                                                                                                                                                                                                                                           
E1037001003TRANSPORT CHAIR, PEDIATRIC SIZE                                                 Transport chair, ped size   36      A60-9                                                                                                 D                          D1D R      02003010120030101        N                           
E1038001003TRANSPORT CHAIR, ADULT SIZE, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300    Transport chair pt wt<=300lb36      A60-9                                                                                                 D                          D1D R      02003010120060101        C                           
E1038002004POUNDS                                                                                                                                                                                                                                                                                                               
E1039001003TRANSPORT CHAIR, ADULT SIZE, HEAVY DUTY, PATIENT WEIGHT CAPACITY GREATER THAN   Transport chair pt wt >300lb36      A                                                                                                     C                          D1D R      02005010120060101        C                           
E1039002004300 POUNDS                                                                                                                                                                                                                                                                                                           
E1050001003FULLY-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE       Whelchr fxd full length arms36      A60-9                                                                                                 D                          D1D R      01986010119840101        N                           
E1050002004ELEVATING LEG RESTS                                                                                                                                                                                                                                                                                                  
E1060001003FULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH, SWING AWAY    Wheelchair detachable arms  36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1060002004DETACHABLE ELEVATING LEGRESTS                                                                                                                                                                                                                                                                                        
E1065001003POWER ATTACHMENT (TO CONVERT ANY WHEELCHAIR TO MOTORIZED WHEELCHAIR, E.G., SOLO)Wheelchair power attachment 32      A60-9                                                                                                 D                          D1D APR    0198601012004010120031231N                           
E1066001003BATTERY CHARGER                                                                 Wheelchair battery charger  00      960-9                                                                                                 I                          D1D APR    0198601012004010120031231N                           
E1069001003DEEP CYCLE BATTERY                                                              Wheelchair deep cycle batter00      960-9                                                                                                 I                          D1D APR    0198601012004010120031231N                           
E1070001003FULLY-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY    Wheelchair detachable foot r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1070002004DETACHABLE FOOTREST                                                                                                                                                                                                                                                                                                  
E1083001003HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG    Hemi-wheelchair fixed arms  36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1083002004REST                                                                                                                                                                                                                                                                                                                 
E1084001003HEMI-WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH ARMS, SWING AWAY           Hemi-wheelchair detachable a36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1084002004DETACHABLE ELEVATING LEG RESTS                                                                                                                                                                                                                                                                                       
E1085001003HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS       Hemi-wheelchair fixed arms  00      960-9                                                                        K0002                    I                          D1D R      01986010120010401        N                           
E1086001003HEMI-WHEELCHAIR DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE      Hemi-wheelchair detachable a00      960-9                                                                        K0002                    I                          D1D R      01986010120010401        N                           
E1086002004FOOTRESTS                                                                                                                                                                                                                                                                                                            
E1087001003HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY        Wheelchair lightwt fixed arm36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1087002004DETACHABLE ELEVATING LEG RESTS                                                                                                                                                                                                                                                                                       
E1088001003HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH,      Wheelchair lightweight det a36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1088002004SWING AWAY DETACHABLE ELEVATING LEG RESTS                                                                                                                                                                                                                                                                            
E1089001003HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED LENGTH ARMS, SWING AWAY DETACHABLE  Wheelchair lightwt fixed arm00      960-9                                                                        K0004                    I                          D1D R      01986010120010401        N                           
E1089002004FOOTREST                                                                                                                                                                                                                                                                                                             
E1090001003HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH,      Wheelchair lightweight det a00      960-9                                                                        K0004                    I                          D1D R      01986010120010401        N                           
E1090002004SWING AWAY DETACHABLE FOOT RESTS                                                                                                                                                                                                                                                                                     
E1091001003YOUTH WHEELCHAIR, ANY TYPE                                                      Wheelchair youth            36      A60-9                                                                                                 D                          D1D R      0198601012003010120021231N                           
E1092001003WIDE HEAVY DUTY WHEEL CHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH), SWING AWAY  Wheelchair wide w/ leg rests36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1092002004DETACHABLE ELEVATING LEG RESTS                                                                                                                                                                                                                                                                                       
E1093001003WIDE HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH ARMS, SWING     Wheelchair wide w/ foot rest36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1093002004AWAY DETACHABLE FOOTRESTS                                                                                                                                                                                                                                                                                            
E1100001003SEMI-RECLINING WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE        Whchr s-recl fxd arm leg res36      A60-9                                                                                                 D                          D1D R      01986010119880101        N                           
E1100002004ELEVATING LEG RESTS                                                                                                                                                                                                                                                                                                  
E1110001003SEMI-RECLINING WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) ELEVATING LEG  Wheelchair semi-recl detach 36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1110002004REST                                                                                                                                                                                                                                                                                                                 
E1130001003STANDARD WHEELCHAIR, FIXED FULL LENGTH ARMS, FIXED OR SWING AWAY DETACHABLE     Whlchr stand fxd arm ft rest00      960-9                                                                        K0001                    I                          D1D R      01986010120010401        N                           
E1130002004FOOTRESTS                                                                                                                                                                                                                                                                                                            
E1140001003WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH, SWING AWAY DETACHABLE         Wheelchair standard detach a00      960-9                                                                        K0001                    I                          D1D R      01986010120010401        N                           
E1140002004FOOTRESTS                                                                                                                                                                                                                                                                                                            
E1150001003WHEELCHAIR, DETACHABLE ARMS, DESK OR FULL LENGTH SWING AWAY DETACHABLE          Wheelchair standard w/ leg r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1150002004ELEVATING LEGRESTS                                                                                                                                                                                                                                                                                                   
E1160001003WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEGRESTS    Wheelchair fixed arms       36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1161001003MANUAL ADULT SIZE WHEELCHAIR, INCLUDES TILT IN SPACE                            Manual adult wc w tiltinspac36      A                                                                                                     C                          D1D APR    02003010120030101        N                           
E1170001003AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING     Whlchr ampu fxd arm leg rest36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1170002004LEGRESTS                                                                                                                                                                                                                                                                                                             
E1171001003AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, WITHOUT FOOTRESTS OR LEGREST        Wheelchair amputee w/o leg r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1172001003AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) WITHOUT FOOTRESTS OR  Wheelchair amputee detach ar36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1172002004LEGREST                                                                                                                                                                                                                                                                                                              
E1180001003AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY DETACHABLE Wheelchair amputee w/ foot r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1180002004FOOTRESTS                                                                                                                                                                                                                                                                                                            
E1190001003AMPUTEE WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY DETACHABLE Wheelchair amputee w/ leg re36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1190002004ELEVATING LEGRESTS                                                                                                                                                                                                                                                                                                   
E1195001003HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING  Wheelchair amputee heavy dut36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1195002004LEGRESTS                                                                                                                                                                                                                                                                                                             
E1200001003AMPUTEE WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST      Wheelchair amputee fixed arm36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1210001003MOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING   Whlchr moto ful arm leg rest36      A60-5  60-9                                                                                           D                          D1D APR    0198601012006010120051231D                           
E1210002004LEG RESTS                                                                                                                                                                                                                                                                                                            
E1211001003MOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH SWING AWAY,           Wheelchair motorized w/ det 36      A60-5  60-9                                                                                           D                          D1D APR    0198801012006010120051231D                           
E1211002004DETACHABLE ELEVATING LEG REST                                                                                                                                                                                                                                                                                        
E1212001003MOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS  Wheelchair motorized w full 00      960-5  60-9                                                                  K0010                    I                          D1D APR    0198801012006010120051231D                           
E1213001003MOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY           Wheelchair motorized w/ det 00      960-5  60-9                                                                  K0010                    I                          D1D APR    0198801012006010120051231D                           
E1213002004DETACHABLE FOOT RESTS                                                                                                                                                                                                                                                                                                
E1220001003WHEELCHAIR; SPECIALLY SIZED OR CONSTRUCTED, (INDICATE BRAND NAME, MODEL NUMBER, Whlchr special size/constrc 45      A60-6                                                                                                 D                          D1D P      01986010119900101        N                           
E1220002004IF ANY) AND JUSTIFICATION                                                                                                                                                                                                                                                                                            
E1221001003WHEELCHAIR WITH FIXED ARM, FOOTRESTS                                            Wheelchair spec size w foot 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1222001003WHEELCHAIR WITH FIXED ARM, ELEVATING LEGRESTS                                   Wheelchair spec size w/ leg 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1223001003WHEELCHAIR WITH DETACHABLE ARMS, FOOTRESTS                                      Wheelchair spec size w foot 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1224001003WHEELCHAIR WITH DETACHABLE ARMS, ELEVATING LEGRESTS                             Wheelchair spec size w/ leg 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1225001003WHEELCHAIR ACCESSORY, MANUAL SEMI-RECLINING BACK, (RECLINE GREATER THAN 15      Manual semi-reclining back  36      A60-6                                                                                                 D                          D1D R      01986010120050101        N                           
E1225002004DEGREES, BUT LESS THAN 80 DEGREES), EACH                                                                                                                                                                                                                                                                             
E1226001003WHEELCHAIR ACCESSORY, MANUAL FULLY RECLINING BACK, (RECLINE GREATER THAN 80     Manual fully reclining back 00      960-9                                                                                                 D                          D1D APR    01986010120050101        N                           
E1226002004DEGREES), EACH                                                                                                                                                                                                                                                                                                       
E1227001003SPECIAL HEIGHT ARMS FOR WHEELCHAIR                                              Wheelchair spec sz spec ht a32      A60-6                                                                                                 D                          D1D APR    01986010119900101        N                           
E1228001003SPECIAL BACK HEIGHT FOR WHEELCHAIR                                              Wheelchair spec sz spec ht b36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1229001003WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIED                             Pediatric wheelchair NOS    32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E1230001003POWER OPERATED VEHICLE (THREE OR FOUR WHEEL NONHIGHWAY) SPECIFY BRAND NAME AND  Power operated vehicle      32      A60-5              4107.6                                                                             D                          D1D APR    01986010119910101        N                           
E1230002004MODEL NUMBER                                                                                                                                                                                                                                                                                                         
E1231001003WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITH SEATING      Rigid ped w/c tilt-in-space 36      A60-9                                                                                                 D                          D1D APR    02003010120030101        N                           
E1231002004SYSTEM                                                                                                                                                                                                                                                                                                               
E1232001003WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITH SEATING    Folding ped wc tilt-in-space36      A60-9                                                                                                 D                          D1D APR    02003010120030101        N                           
E1232002004SYSTEM                                                                                                                                                                                                                                                                                                               
E1233001003WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, RIGID, ADJUSTABLE, WITHOUT SEATING   Rig ped wc tltnspc w/o seat 36      A60-9                                                                                                 D                          D1D APR    02003010120030101        N                           
E1233002004SYSTEM                                                                                                                                                                                                                                                                                                               
E1234001003WHEELCHAIR, PEDIATRIC SIZE, TILT-IN-SPACE, FOLDING, ADJUSTABLE, WITHOUT SEATING Fld ped wc tltnspc w/o seat 36      A60-9                                                                                                 D                          D1D APR    02003010120030101        N                           
E1234002004SYSTEM                                                                                                                                                                                                                                                                                                               
E1235001003WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITH SEATING SYSTEM              Rigid ped wc adjustable     36      A60-9                                                                                                 D                          D1D APR    02003010120030101        N                           
E1236001003WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITH SEATING SYSTEM            Folding ped wc adjustable   36      A60-9                                                                                                 D                          D1D APR    02003010120030101        N                           
E1237001003WHEELCHAIR, PEDIATRIC SIZE, RIGID, ADJUSTABLE, WITHOUT SEATING SYSTEM           Rgd ped wc adjstabl w/o seat36      A60-9                                                                                                 D                          D1D APR    02003010120030101        N                           
E1238001003WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITHOUT SEATING SYSTEM         Fld ped wc adjstabl w/o seat36      A60-9                                                                                                 D                          D1D APR    02003010120030101        N                           
E1239001003POWER WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIED                       Ped power wheelchair NOS    36      A                                                                                                     C                          D1D APR    0200501012006010120051231D                           
E1240001003LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS, (DESK OR FULL LENGTH) SWING AWAY       Whchr litwt det arm leg rest36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1240002004DETACHABLE, ELEVATING LEGREST                                                                                                                                                                                                                                                                                        
E1250001003LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST  Wheelchair lightwt fixed arm00      960-9                                                                        K0003                    I                          D1D R      01986010120010401        N                           
E1260001003LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY        Wheelchair lightwt foot rest00      960-9                                                                        K0003                    I                          D1D R      01986010120010401        N                           
E1260002004DETACHABLE FOOTREST                                                                                                                                                                                                                                                                                                  
E1270001003LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING Wheelchair lightweight leg r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1270002004LEGRESTS                                                                                                                                                                                                                                                                                                             
E1280001003HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) ELEVATING LEGRESTS Whchr h-duty det arm leg res36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1285001003HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST   Wheelchair heavy duty fixed 00      960-9                                                                        K0006                    I                          D1D R      01986010120010401        N                           
E1290001003HEAVY DUTY WHEELCHAIR, DETACHABLE ARMS (DESK OR FULL LENGTH) SWING AWAY         Wheelchair hvy duty detach a00      960-9                                                                        K0006                    I                          D1D R      01986010120010401        N                           
E1290002004DETACHABLE FOOTREST                                                                                                                                                                                                                                                                                                  
E1295001003HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, ELEVATING LEGREST                Wheelchair heavy duty fixed 36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1296001003SPECIAL WHEELCHAIR SEAT HEIGHT FROM FLOOR                                       Wheelchair special seat heig32      A60-6                                                                                                 D                          D1D APR    01986010119890101        N                           
E1297001003SPECIAL WHEELCHAIR SEAT DEPTH, BY UPHOLSTERY                                    Wheelchair special seat dept32      A60-6                                                                                                 D                          D1D APR    01986010119890101        N                           
E1298001003SPECIAL WHEELCHAIR SEAT DEPTH AND/OR WIDTH, BY CONSTRUCTION                     Wheelchair spec seat depth/w32      A60-6                                                                                                 D                          D1D APR    01986010119890101        N                           
E1300001003WHIRLPOOL, PORTABLE (OVERTUB TYPE)                                              Whirlpool portable          00      960-9                                                                                                 M                          D1E APR    01986010119960101        N                           
E1310001003WHIRLPOOL, NON-PORTABLE (BUILT-IN TYPE)                                         Whirlpool non-portable      32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E1340001003REPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT REQUIRING THE SKILL  Repair for DME, per 15 min  46      A                  2100.4                                                                             D                          D1E 9      01997010119970101        N                           
E1340002004OF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES                                                                                                                                                                                                                                                                     
E1353001003REGULATOR                                                                       Oxygen supplies regulator   33      A60-4              4107.9                                                                             D                          D1C R      01986010119890101        N                           
E1355001003STAND/RACK                                                                      Oxygen supplies stand/rack  33      A60-4                                                                                                 D                          D1C R      01986010119890101        N                           
E1372001003IMMERSION EXTERNAL HEATER FOR NEBULIZER                                         Oxy suppl heater for nebuliz32      A60-4                                                                                                 D                          D1E APR    01986010119960101        N                           
E1390001003OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR  Oxygen concentrator         33      A60-4                                                                                                 D                          D1C R      02000010120040101        N                           
E1390002004GREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE                                                                                                                                                                                                                                                             
E1391001003OXYGEN CONCENTRATOR, DUAL DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR    Oxygen concentrator, dual   33      A60-4                                                                                                 D                          D1C R      02004010120040101        N                           
E1391002004GREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE, EACH                                                                                                                                                                                                                                                       
E1392001003PORTABLE OXYGEN CONCENTRATOR, RENTAL                                            Portable oxygen concentrator33      A60-4                                                                                                 D                          D1C R      02006010120060101        A                           
E1399001003DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS                                        Durable medical equipment mi46      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E1405001003OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITH HEATED DELIVERY                    O2/water vapor enrich w/heat33      A60-4              4107                                                                               D                          D1C R      01988010119900101        N                           
E1406001003OXYGEN AND WATER VAPOR ENRICHING SYSTEM WITHOUT HEATED DELIVERY                 O2/water vapor enrich w/o he33      A60-4              4107                                                                               D                          D1C R      01988010119900101        N                           
E1500001003CENTRIFUGE, FOR DIALYSIS                                                        Centrifuge                  52      A                                                                                                     D                      0017P9B L      02002010120020101        N                           
E1510001003KIDNEY, DIALYSATE DELIVERY SYST. KIDNEY MACHINE, PUMP RECIRCULAT- ING, AIR      Kidney dialysate delivry sys52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1510002004REMOVAL SYST, FLOWRATE METER, POWER OFF, HEATER AND TEMPERATURE CONTROL WITH                                                                                                                                                                                                                                         
E1510003004ALARM, I.V.POLES, PRESSURE GAUGE, CONCENTRATE CONTAINER                                                                                                                                                                                                                                                              
E1520001003HEPARIN INFUSION PUMP FOR HEMODIALYSIS                                          Heparin infusion pump       52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1530001003AIR BUBBLE DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT                         Replacement air bubble detec52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1540001003PRESSURE ALARM FOR HEMODIALYSIS, EACH, REPLACEMENT                              Replacement pressure alarm  52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1550001003BATH CONDUCTIVITY METER FOR HEMODIALYSIS, EACH                                  Bath conductivity meter     52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1560001003BLOOD LEAK DETECTOR FOR HEMODIALYSIS, EACH, REPLACEMENT                         Replace blood leak detector 52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1570001003ADJUSTABLE CHAIR, FOR ESRD PATIENTS                                             Adjustable chair for esrd pt52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1575001003TRANSDUCER PROTECTORS/FLUID BARRIERS, FOR HEMODIALYSIS, ANY SIZE, PER 10        Transducer protect/fld bar  52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1580001003UNIPUNCTURE CONTROL SYSTEM FOR HEMODIALYSIS                                     Unipuncture control system  52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1590001003HEMODIALYSIS MACHINE                                                            Hemodialysis machine        52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1592001003AUTOMATIC INTERMITTENT PERITIONEAL DIALYSIS SYSTEM                              Auto interm peritoneal dialy52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1594001003CYCLER DIALYSIS MACHINE FOR PERITONEAL DIALYSIS                                 Cycler dialysis machine     52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1600001003DELIVERY AND/OR INSTALLATION CHARGES FOR HEMODIALYSIS EQUIPMENT                 Deli/install chrg hemo equip52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1610001003REVERSE OSMOSIS WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS                     Reverse osmosis h2o puri sys52      A55-1A                                                                                                D                      0017P9B L      01986010120020101        N                           
E1615001003DEIONIZER WATER PURIFICATION SYSTEM, FOR HEMODIALYSIS                           Deionizer H2O puri system   52      A55-1A                                                                                                D                      0017P9B L      01986010120020101        N                           
E1620001003BLOOD PUMP FOR HEMODIALYSIS, REPLACEMENT                                        Replacement blood pump      52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1625001003WATER SOFTENING SYSTEM, FOR HEMODIALYSIS                                        Water softening system      52      A55-1B                                                                                                D                      0017P9B L      01986010120020101        N                           
E1630001003RECIPROCATING PERITONEAL DIALYSIS SYSTEM                                        Reciprocating peritoneal dia52      A                                                                                                     C                      0017P9B L      01986010120020101        N                           
E1632001003WEARABLE ARTIFICIAL KIDNEY, EACH                                                Wearable artificial kidney  52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1634001003PERITONEAL DIALYSIS CLAMPS, EACH                                                Peritoneal dialysis clamp   52      A                  4270                                                                               D                          P9B L      02004010120040101        N                           
E1635001003COMPACT (PORTABLE) TRAVEL HEMODIALYZER SYSTEM                                   Compact travel hemodialyzer 52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1636001003SORBENT CARTRIDGES, FOR HEMODIALYSIS, PER 10                                    Sorbent cartridges per 10   52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1637001003HEMOSTATS, EACH                                                                 Hemostats for dialysis, each52      A                                                                                                     D                      0017P9B L      02002010120030101        N                           
E1638001003HEATING PAD, FOR PERITONEAL DIALYSIS, ANY SIZE, EACH                            Peri dialysis heating pad   52      A                                                                            E0210                    D                      0017P9B L      0200201012003010120021231N                           
E1639001003SCALE, EACH                                                                     Dialysis scale              52      A                                                                                                     D                      0017P9B L      02002010120030101        N                           
E1699001003DIALYSIS EQUIPMENT, NOT OTHERWISE SPECIFIED                                     Dialysis equipment noc      52      A                                                                                                     D                      0017P9B L      01986010120020101        N                           
E1700001003JAW MOTION REHABILITATION SYSTEM                                                Jaw motion rehab system     32      A                                                                                                     C                          D1E APR    01993010119971020        N                           
E1701001003REPLACEMENT CUSHIONS FOR JAW MOTION REHABILITATION SYSTEM, PKG. OF 6            Repl cushions for jaw motion34      A                                                                                                     C                          D1E P      01993010119960101        N                           
E1702001003REPLACEMENT MEASURING SCALES FOR JAW MOTION REHABILITATION SYSTEM, PKG. OF 200  Repl measr scales jaw motion34      A                                                                                                     C                          D1E P      01993010119960101        N                           
E1800001003DYNAMIC ADJUSTABLE ELBOW EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE      Adjust elbow ext/flex device36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1800002004MATERIAL                                                                                                                                                                                                                                                                                                             
E1801001003BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH ELBOW DEVICE WITH RANGE OF MOTION     SPS elbow device            36      A                                                                                                     C                          D1E PR     02002010120020101        N                           
E1801002004ADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                                           
E1802001003DYNAMIC ADJUSTABLE FOREARM PRONATION/SUPINATION DEVICE, INCLUDES SOFT INTERFACE Adjst forearm pro/sup device36      A                                                                                                     C                          D1E R      02003010120030101        N                           
E1802002004MATERIAL                                                                                                                                                                                                                                                                                                             
E1805001003DYNAMIC ADJUSTABLE WRIST EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE    Adjust wrist ext/flex device36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1805002004MATERIAL                                                                                                                                                                                                                                                                                                             
E1806001003BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH WRIST DEVICE WITH RANGE OF MOTION     SPS wrist device            36      A                                                                                                     C                          D1E PR     02002010120020101        N                           
E1806002004ADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                                           
E1810001003DYNAMIC ADJUSTABLE KNEE EXTENSION / FLEXION DEVICE, INCLUDES SOFT INTERFACE     Adjust knee ext/flex device 36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1810002004MATERIAL                                                                                                                                                                                                                                                                                                             
E1811001003BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH KNEE DEVICE WITH RANGE OF MOTION      SPS knee device             36      A                                                                                                     C                          D1E PR     02002010120020101        N                           
E1811002004ADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                                           
E1812001003DYNAMIC KNEE, EXTENSION/FLEXION DEVICE WITH ACTIVE RESISTANCE CONTROL           Knee ext/flex w act res ctrl36      A                                                                                                     C                          D1E PR     02006010120060101        A                           
E1815001003DYNAMIC ADJUSTABLE ANKLE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE      Adjust ankle ext/flex device36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1815002004MATERIAL                                                                                                                                                                                                                                                                                                             
E1816001003BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH ANKLE DEVICE WITH RANGE OF MOTION     SPS ankle device            36      A                                                                                                     C                          D1E PR     02002010120020101        N                           
E1816002004ADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                                           
E1818001003BI-DIRECTIONAL STATIC PROGRESSIVE STRETCH FOREARM PRONATION / SUPINATION DEVICE SPS forearm device          36      A                                                                                                     C                          D1E PR     02002010120020101        N                           
E1818002004WITH RANGE OF MOTION ADJUSTMENT, INCLUDES CUFFS                                                                                                                                                                                                                                                                      
E1820001003REPLACEMENT SOFT INTERFACE MATERIAL, DYNAMIC ADJUSTABLE EXTENSION/FLEXION DEVICESoft interface material     32      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1821001003REPLACEMENT SOFT INTERFACE MATERIAL/CUFFS FOR BI-DIRECTIONAL STATIC PROGRESSIVE Replacement interface SPSD  32      A                                                                                                     C                          D1E PR     02002010120020101        N                           
E1821002004STRETCH DEVICE                                                                                                                                                                                                                                                                                                       
E1825001003DYNAMIC ADJUSTABLE FINGER EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE     Adjust finger ext/flex devc 36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1825002004MATERIAL                                                                                                                                                                                                                                                                                                             
E1830001003DYNAMIC ADJUSTABLE TOE EXTENSION/FLEXION DEVICE, INCLUDES SOFT INTERFACE        Adjust toe ext/flex device  36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1830002004MATERIAL                                                                                                                                                                                                                                                                                                             
E1840001003DYNAMIC ADJUSTABLE SHOULDER FLEXION / ABDUCTION / ROTATION DEVICE, INCLUDES     Adj shoulder ext/flex device36      A                                                                                                     C                          D1E PR     02002010120020101        N                           
E1840002004SOFT INTERFACE MATERIAL                                                                                                                                                                                                                                                                                              
E1841001003MULTI-DIRECTIONAL STATIC PROGRESSIVE STRETCH SHOULDER DEVICE, WITH RANGE OF     Static str shldr dev rom adj36      A                                                                                                     C                          D1E R      02005010120050101        N                           
E1841002004MOTION ADJUSTABILITY, INCLUDES CUFFS                                                                                                                                                                                                                                                                                 
E1902001003COMMUNICATION BOARD, NON-ELECTRONIC AUGMENTATIVE OR ALTERNATIVE COMMUNICATION   AAC non-electronic board    00      9                                                                                                     C                          Z2  APR    02002010120020101        N                           
E1902002004DEVICE                                                                                                                                                                                                                                                                                                               
E2000001003GASTRIC SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC              Gastric suction pump hme mdl36      A                                                                                                     C                          D1E R      02002010120020101        N                           
E2100001003BLOOD GLUCOSE MONITOR WITH INTEGRATED VOICE SYNTHESIZER                         Bld glucose monitor w voice 32      A60-11                                                                                                D                          D1E APR    02002010120020101        N                           
E2101001003BLOOD GLUCOSE MONITOR WITH INTEGRATED LANCING/BLOOD SAMPLE                      Bld glucose monitor w lance 32      A60-11                                                                                                D                          D1E APR    02002010120020101        N                           
E2120001003PULSE GENERATOR SYSTEM FOR TYMPANIC TREATMENT OF INNER EAR ENDOLYMPHATIC FLUID  Pulse gen sys tx endolymp fl36      A                                                                                                     C                          D1E R      02004010120040101        N                           
E2201001003MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME, WIDTH GREATER THAN OR      Man w/ch acc seat w>=20<2432      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2201002004EQUAL TO 20 INCHES AND LESS THAN 24 INCHES                                                                                                                                                                                                                                                                           
E2202001003MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 24-27 INCHES         Seat width 24-27 in         32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2203001003MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 20 TO LESS THAN 22   Frame depth less than 22 in 32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2203002004INCHES                                                                                                                                                                                                                                                                                                               
E2204001003MANUAL WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 22 TO 25 INCHES      Frame depth 22 to 25 in     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2205001003MANUAL WHEELCHAIR ACCESSORY, HANDRIM WITHOUT PROJECTIONS, ANY TYPE, REPLACEMENT Manual wc accessory, handrim32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2205002004ONLY, EACH                                                                                                                                                                                                                                                                                                           
E2206001003MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK ASSEMBLY, COMPLETE, EACH                Complete wheel lock assembly32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2207001003WHEELCHAIR ACCESSORY, CRUTCH AND CANE HOLDER, EACH                              Crutch and cane holder      32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2208001003WHEELCHAIR ACCESSORY, CYLINDER TANK CARRIER, EACH                               Cylinder tank carrier       32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2209001003WHEELCHAIR ACCESSORY, ARM TROUGH, EACH                                          Arm trough each             32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2210001003WHEELCHAIR ACCESSORY, BEARINGS, ANY TYPE, REPLACEMENT ONLY, EACH                Wheelchair bearings         32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2211001003MANUAL WHEELCHAIR ACCESSORY, PNEUMATIC PROPULSION TIRE, ANY SIZE, EACH          Pneumatic propulsion tire   32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2212001003MANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC PROPULSION TIRE, ANY SIZE, EACH Pneumatic prop tire tube    32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2213001003MANUAL WHEELCHAIR ACCESSORY, INSERT FOR PNEUMATIC PROPULSION TIRE (REMOVABLE),  Pneumatic prop tire insert  32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2213002004ANY TYPE, ANY SIZE, EACH                                                                                                                                                                                                                                                                                             
E2214001003MANUAL WHEELCHAIR ACCESSORY, PNEUMATIC CASTER TIRE, ANY SIZE, EACH              Pneumatic caster tire each  32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2215001003MANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC CASTER TIRE, ANY SIZE, EACH     Pneumatic caster tire tube  32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2216001003MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED PROPULSION TIRE, ANY SIZE, EACH        Foam filled propulsion tire 32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2217001003MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED CASTER TIRE, ANY SIZE, EACH            Foam filled caster tire each32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2218001003MANUAL WHEELCHAIR ACCESSORY, FOAM PROPULSION TIRE, ANY SIZE, EACH               Foam propulsion tire each   32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2219001003MANUAL WHEELCHAIR ACCESSORY, FOAM CASTER TIRE, ANY SIZE, EACH                   Foam caster tire any size ea32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2220001003MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) PROPULSION TIRE, ANY SIZE,  Solid propulsion tire each  32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2220002004EACH                                                                                                                                                                                                                                                                                                                 
E2221001003MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE),    Solid caster tire each      32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2221002004ANY SIZE, EACH                                                                                                                                                                                                                                                                                                       
E2222001003MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED Solid caster integrated whl 32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2222002004WHEEL, ANY SIZE, EACH                                                                                                                                                                                                                                                                                                
E2223001003MANUAL WHEELCHAIR ACCESSORY, VALVE, ANY TYPE, REPLACEMENT ONLY, EACH            Valve replacement only each 32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2224001003MANUAL WHEELCHAIR ACCESSORY, PROPULSION WHEEL EXCLUDES TIRE, ANY SIZE, EACH     Propulsion whl excludes tire32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2225001003MANUAL WHEELCHAIR ACCESSORY, CASTER WHEEL EXCLUDES TIRE, ANY SIZE, REPLACEMENT  Caster wheel excludes tire  32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2225002004ONLY, EACH                                                                                                                                                                                                                                                                                                           
E2226001003MANUAL WHEELCHAIR ACCESSORY, CASTER FORK, ANY SIZE, REPLACEMENT ONLY, EACH      Caster fork replacement only32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2291001003BACK, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE  Planar back for ped size wc 00      9                                                                                                     I                          D1E APR    02005010120050101        N                           
E2292001003SEAT, PLANAR, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING HARDWARE  Planar seat for ped size wc 00      9                                                                                                     I                          D1E APR    02005010120050101        N                           
E2293001003BACK, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING        Contour back for ped size wc00      9                                                                                                     I                          D1E APR    02005010120050101        N                           
E2293002004HARDWARE                                                                                                                                                                                                                                                                                                             
E2294001003SEAT, CONTOURED, FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING        Contour seat for ped size wc00      9                                                                                                     I                          D1E APR    02005010120050101        N                           
E2294002004HARDWARE                                                                                                                                                                                                                                                                                                             
E2300001003POWER WHEELCHAIR ACCESSORY, POWER SEAT ELEVATION SYSTEM                         Pwr seat elevation sys      32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2301001003POWER WHEELCHAIR ACCESSORY, POWER STANDING SYSTEM                               Pwr standing                32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2310001003POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER Electro connect btw control 32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2310002004AND ONE POWER SEATING SYSTEM MOTOR, INCLUDING ALL RELATED ELECTRONICS,                                                                                                                                                                                                                                               
E2310003004INDICATOR FEATURE, MECHANICAL FUNCTION SELECTION SWITCH, AND FIXED MOUNTING                                                                                                                                                                                                                                          
E2310004004HARDWARE                                                                                                                                                                                                                                                                                                             
E2311001003POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLER Electro connect btw 2 sys   32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2311002004AND TWO OR MORE POWER SEATING SYSTEM MOTORS, INCLUDING ALL RELATED ELECTRONICS,                                                                                                                                                                                                                                      
E2311003004INDICATOR FEATURE, MECHANICAL FUNCTION SELECTION SWITCH, AND FIXED MOUNTING                                                                                                                                                                                                                                          
E2311004004HARDWARE                                                                                                                                                                                                                                                                                                             
E2320001003POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, REMOTE JOYSTICK OR  Hand chin control           32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2320002004TOUCHPAD, PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, AND FIXED MOUNTING                                                                                                                                                                                                                                        
E2320003004HARDWARE                                                                                                                                                                                                                                                                                                             
E2321001003POWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE, REMOTE JOYSTICK,            Hand interface joystick     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2321002004NONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH, AND                                                                                                                                                                                                                                      
E2321003004FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                                                                              
E2322001003POWER WHEELCHAIR ACCESSORY, HAND CONTROL INTERFACE, MULTIPLE MECHANICAL         Mult mech switches          32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2322002004SWITCHES, NONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP                                                                                                                                                                                                                                        
E2322003004SWITCH, AND FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                                                                  
E2323001003POWER WHEELCHAIR ACCESSORY, SPECIALTY JOYSTICK HANDLE FOR HAND CONTROL          Special joystick handle     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2323002004INTERFACE, PREFABRICATED                                                                                                                                                                                                                                                                                             
E2324001003POWER WHEELCHAIR ACCESSORY, CHIN CUP FOR CHIN CONTROL INTERFACE                 Chin cup interface          32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2325001003POWER WHEELCHAIR ACCESSORY, SIP AND PUFF INTERFACE, NONPROPORTIONAL, INCLUDING  Sip and puff interface      32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2325002004ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH, AND MANUAL SWINGAWAY MOUNTING                                                                                                                                                                                                                                       
E2325003004HARDWARE                                                                                                                                                                                                                                                                                                             
E2326001003POWER WHEELCHAIR ACCESSORY, BREATH TUBE KIT FOR SIP AND PUFF INTERFACE          Breath tube kit             32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2327001003POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, MECHANICAL, PROPORTIONAL,   Head control interface mech 32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2327002004INCLUDING ALL RELATED ELECTRONICS, MECHANICAL DIRECTION CHANGE SWITCH, AND                                                                                                                                                                                                                                           
E2327003004FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                                                                              
E2328001003POWER WHEELCHAIR ACCESSORY, HEAD CONTROL OR EXTREMITY CONTROL INTERFACE,        Head/extremity control inter32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2328002004ELECTRONIC, PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS AND FIXED MOUNTING                                                                                                                                                                                                                                       
E2328003004HARDWARE                                                                                                                                                                                                                                                                                                             
E2329001003POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, CONTACT SWITCH MECHANISM,   Head control nonproportional32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2329002004NONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH,                                                                                                                                                                                                                                          
E2329003004MECHANICAL DIRECTION CHANGE SWITCH, HEAD ARRAY, AND FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                          
E2330001003POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, PROXIMITY SWITCH MECHANISM, Head control proximity switc32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2330002004NONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH,                                                                                                                                                                                                                                          
E2330003004MECHANICAL DIRECTION CHANGE SWITCH, HEAD ARRAY, AND FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                          
E2331001003POWER WHEELCHAIR ACCESSORY, ATTENDANT CONTROL, PROPORTIONAL, INCLUDING ALL      Attendant control           32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2331002004RELATED ELECTRONICS AND FIXED MOUNTING HARDWARE                                                                                                                                                                                                                                                                      
E2340001003POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 20-23 INCHES          W/c wdth 20-23 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2341001003POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 24-27 INCHES          W/c wdth 24-27 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2342001003POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 20 OR 21 INCHES       W/c dpth 20-21 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2343001003POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 22-25 INCHES          W/c dpth 22-25 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2351001003POWER WHEELCHAIR ACCESSORY, ELECTRONIC INTERFACE TO OPERATE SPEECH GENERATING   Electronic SGD interface    32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2351002004DEVICE USING POWER WHEELCHAIR CONTROL INTERFACE                                                                                                                                                                                                                                                                      
E2360001003POWER WHEELCHAIR ACCESSORY, 22 NF NON-SEALED LEAD ACID BATTERY, EACH            22nf nonsealed leadacid     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2361001003POWER WHEELCHAIR ACCESSORY, 22NF SEALED LEAD ACID BATTERY, EACH, (E.G. GEL      22nf sealed leadacid battery32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2361002004CELL, ABSORBED GLASSMAT)                                                                                                                                                                                                                                                                                             
E2362001003POWER WHEELCHAIR ACCESSORY, GROUP 24 NON-SEALED LEAD ACID BATTERY, EACH         Gr24 nonsealed leadacid     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2363001003POWER WHEELCHAIR ACCESSORY, GROUP 24 SEALED LEAD ACID BATTERY, EACH (E.G. GEL   Gr24 sealed leadacid battery32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2363002004CELL, ABSORBED GLASSMAT)                                                                                                                                                                                                                                                                                             
E2364001003POWER WHEELCHAIR ACCESSORY, U-1 NON-SEALED LEAD ACID BATTERY, EACH              U1nonsealed leadacid battery32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2365001003POWER WHEELCHAIR ACCESSORY, U-1 SEALED LEAD ACID BATTERY, EACH (E.G. GEL CELL,  U1 sealed leadacid battery  32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2365002004ABSORBED GLASSMAT)                                                                                                                                                                                                                                                                                                   
E2366001003POWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, SINGLE MODE, FOR USE WITH ONLY ONE Battery charger, single mode32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2366002004BATTERY TYPE, SEALED OR NON-SEALED, EACH                                                                                                                                                                                                                                                                             
E2367001003POWER WHEELCHAIR ACCESSORY, BATTERY CHARGER, DUAL MODE, FOR USE WITH EITHER     Battery charger, dual mode  32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2367002004BATTERY TYPE, SEALED OR NON-SEALED, EACH                                                                                                                                                                                                                                                                             
E2368001003POWER WHEELCHAIR COMPONENT, MOTOR, REPLACEMENT ONLY                             Power wc motor replacement  32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2369001003POWER WHEELCHAIR COMPONENT, GEAR BOX, REPLACEMENT ONLY                          Pwr wc gear box replacement 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2370001003POWER WHEELCHAIR COMPONENT, MOTOR AND GEAR BOX COMBINATION, REPLACEMENT ONLY    Pwr wc motor/gear box combo 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2371001003POWER WHEELCHAIR ACCESSORY, GROUP 27 SEALED LEAD ACID BATTERY, (E.G. GEL CELL,  Gr27 sealed leadacid battery32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2371002004ABSORBED GLASSMAT), EACH                                                                                                                                                                                                                                                                                             
E2372001003POWER WHEELCHAIR ACCESSORY, GROUP 27 NON-SEALED LEAD ACID BATTERY, EACH         Gr27 non-sealed leadacid    32      A                                                                                                     C                          D1D APR    02006010120060101        A                           
E2399001003POWER WHEELCHAIR ACCESSORY, NOT OTHERWISE CLASSIFIED INTERFACE, INCLUDING ALL   Noc interface               32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2399002004RELATED ELECTRONICS AND ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                   
E2402001003NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE         Neg press wound therapy pump36      A                                                                                                     C                          D1E R      02004010120040101        N                           
E2500001003SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES, LESS   SGD digitized pre-rec <=8min32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2500002004THAN OR EQUAL TO 8 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                            
E2502001003SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec msg >8min <=20min32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2502002004GREATER THAN 8 MINUTES BUT LESS THAN OR EQUAL TO 20 MINUTES RECORDING TIME                                                                                                                                                                                                                                           
E2504001003SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec msg>20min <=40min32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2504002004GREATER THAN 20 MINUTES BUT LESS THAN OR EQUAL TO 40 MINUTES RECORDING TIME                                                                                                                                                                                                                                          
E2506001003SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec msg > 40 min     32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2506002004GREATER THAN 40 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                               
E2508001003SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, REQUIRING MESSAGE FORMULATION BY  SGD spelling phys contact   32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2508002004SPELLING AND ACCESS BY PHYSICAL CONTACT WITH THE DEVICE                                                                                                                                                                                                                                                              
E2510001003SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, PERMITTING MULTIPLE METHODS OF    SGD w multi methods msg/accs32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2510002004MESSAGE FORMULATION AND MULTIPLE METHODS OF DEVICE ACCESS                                                                                                                                                                                                                                                            
E2511001003SPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL COMPUTER OR PERSONAL DIGITAL   SGD sftwre prgrm for PC/PDA 32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2511002004ASSISTANT                                                                                                                                                                                                                                                                                                            
E2512001003ACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING SYSTEM                         SGD accessory, mounting sys 32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2599001003ACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERWISE CLASSIFIED                SGD accessory noc           32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2601001003GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH       Gen w/c cushion wdth < 22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2602001003GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH      Gen w/c cushion wdth >=22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2603001003SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH   Skin protect wc cus wd <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2604001003SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH  Skin protect wc cus wd>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2605001003POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH       Position wc cush wdth <22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2606001003POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH      Position wc cush wdth>=22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2607001003SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22     Skin pro/pos wc cus wd <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2607002004INCHES, ANY DEPTH                                                                                                                                                                                                                                                                                                    
E2608001003SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR     Skin pro/pos wc cus wd>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2608002004GREATER, ANY DEPTH                                                                                                                                                                                                                                                                                                   
E2609001003CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE                             Custom fabricate w/c cushion32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2610001003WHEELCHAIR SEAT CUSHION, POWERED                                                Powered w/c cushion         32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2611001003GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS THAN 22 INCHES, ANY HEIGHT,     Gen use back cush wdth <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2611002004INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                 
E2612001003GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCHES OR GREATER, ANY HEIGHT,    Gen use back cush wdth>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2612002004INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                 
E2613001003POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH LESS THAN 22 INCHES, ANY  Position back cush wd <22in 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2613002004HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                         
E2614001003POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH 22 INCHES OR GREATER, ANY Position back cush wd>=22in 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2614002004HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                         
E2615001003POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH LESS THAN 22      Pos back post/lat wdth <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2615002004INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                             
E2616001003POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH 22 INCHES OR      Pos back post/lat wdth>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2616002004GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                            
E2617001003CUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE         Custom fab w/c back cushion 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2617002004MOUNTING HARDWARE                                                                                                                                                                                                                                                                                                    
E2618001003WHEELCHAIR ACCESSORY, SOLID SEAT SUPPORT BASE (REPLACES SLING SEAT), FOR USE    Wc acc solid seat supp base 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2618002004WITH MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, INCLUDES ANY TYPE                                                                                                                                                                                                                                            
E2618003004MOUNTING HARDWARE                                                                                                                                                                                                                                                                                                    
E2619001003REPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR BACK CUSHION, EACH             Replace cover w/c seat cush 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2620001003POSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK WITH LATERAL SUPPORTS, WIDTH   WC planar back cush wd <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2620002004LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                
E2621001003POSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK WITH LATERAL SUPPORTS, WIDTH   WC planar back cush wd>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E262100200422 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                               
E8000001003GAIT TRAINER, PEDIATRIC SIZE, POSTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND   Posterior gait trainer      00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
E8000002004COMPONENTS                                                                                                                                                                                                                                                                                                           
E8001001003GAIT TRAINER, PEDIATRIC SIZE, UPRIGHT SUPPORT, INCLUDES ALL ACCESSORIES AND     Upright gait trainer        00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
E8001002004COMPONENTS                                                                                                                                                                                                                                                                                                           
E8002001003GAIT TRAINER, PEDIATRIC SIZE, ANTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND    Anterior gait trainer       00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
E8002002004COMPONENTS                                                                                                                                                                                                                                                                                                           
G0001001003ROUTINE VENIPUNCTURE FOR COLLECTION OF SPECIMEN(S)                              Drawing blood for specimen  22      A                                                                                                     C                      0040T1A 5      0199401012005010120041231N                           
G0002001003OFFICE PROCEDURE, INSERTION OF TEMPORARY INDWELLING CATHETER, FOLEY TYPE        Temporary urinary catheter  11      A                                                                            5170251703               C                          P6C 2      0199401012003010120021231N                           
G0002002004(SEPARATE PROCEDURE)                                                                                                                                                                                                                                                                                                 
G0004001003PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRE-SYMPTOM MEMORY LOOP  ECG transm phys review & int11      A50-15                                                                       93268                    D                          T2C 5      0199501012003010120021231N                           
G0004002004AND 24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; INCLUDES TRANSMISSION,                                                                                                                                                                                                                                           
G0004003004PHYSICIAN REVIEW AND INTERPRETATION                                                                                                                                                                                                                                                                                  
G0005001003PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRE-SYMPTOM MEMORY LOOP  ECG 24 hour recording       11      A50-15                                                                       93270                    D                          T2C 5      0199501012003010120021231N                           
G0005002004AND 24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; RECORDING (INCLUDES                                                                                                                                                                                                                                              
G0005003004HOOK-UP, RECORDING AND DISCONNECTION)                                                                                                                                                                                                                                                                                
G0006001003PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRE-SYMPTOM MEMORY LOOP  ECG transmission & analysis 11      A50-15                                                                       93271                    D                          T2C 5      0199501012003010120021231N                           
G0006002004AND 24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; 24 HOUR ATTENDED                                                                                                                                                                                                                                                 
G0006003004MONITORING, RECEIPT OF TRANSMISSIONS, AND ANALYSIS                                                                                                                                                                                                                                                                   
G0007001003PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRE-SYMPTON MEMORY LOOP  ECG phy review & interpret  11      A50-15                                                                       93272                    D                          T2C 5      0199501012003010120021231N                           
G0007002004AND 24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; PHYSICIAN REVIEW AND                                                                                                                                                                                                                                             
G0007003004INTERPRETATION ONLY                                                                                                                                                                                                                                                                                                  
G0008001003ADMINISTRATION OF INFLUENZA VIRUS VACCINE                                       Admin influenza virus vac   54      A                                                                                                     C                          O1G V      01994010119960101        N                           
G0009001003ADMINISTRATION OF PNEUMOCOCCAL VACCINE                                          Admin pneumococcal vaccine  54      A                                                                                                     C                          O1G V      01994010119960101        N                           
G0010001003ADMINISTRATION OF HEPATITIS B VACCINE                                           Admin hepatitis b vaccine   54      A                                                                                                     C                          O1G 1      01994010119960101        N                           
G0015001003POST-SYMPTOM TELEPHONIC TRANSMISSION OF ELECTROCARDIOGRAM RHYTHM STRIP(S) AND   Post symptom ECG tracing    11      A50-15                                                                       93012                    D                          T2C 5      0199501012003010120021231N                           
G001500200424 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD; TRACING ONLY                                                                                                                                                                                                                                                         
G0025001003COLLAGEN SKIN TEST KIT                                                          Collagen skin test kit      00      9                                                                            Q3031                    I                          D1A S      0199501012003040120030331N                           
G0026001003FECAL LEUCOCYTE EXAMINATION                                                     Fecal leukocyte examination 21      A                                                    400                                              C                          T1H 5      0199501012003010120021231N                           
G0027001003SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER              Semen analysis              21      A                                                    400                                              C                          T1H 5      01995010120031001        N                           
G0030001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); SINGLE PET imaging prev PET single 1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0030002004STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                
G0031001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047);        PET imaging prev PET multple1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0031002004MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                     
G0032001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); SINGLE STUDY,  PET follow SPECT 78464 singl1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0032002004REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                       
G0033001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); MULTIPLE       PET follow SPECT 78464 mult 1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0033002004STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                              
G0034001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); SINGLE       PET follow SPECT 76865 singl1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0034002004STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                
G0035001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); MULTIPLE     PET follow SPECT 78465 mult 1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0035002004STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                              
G0036001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY,              PET follow cornry angio sing1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G003600200493510-93529); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                           
G0037001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY,              PET follow cornry angio mult1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G003700200493510-93529); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                       
G0038001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL           PET follow myocard perf sing1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0038002004PERFUSION, 78460); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                      
G0039001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL           PET follow myocard perf mult1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0039002004PERFUSION, 78460); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR                                                                                                                                                                                                                                                 
G0039003004PHARMACOLOGIC)                                                                                                                                                                                                                                                                                                       
G0040001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350);     PET follow stress echo singl1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0040002004SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                         
G0041001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350);     PET follow stress echo mult 1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0041002004MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                     
G0042001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM,     PET follow ventriculogm sing1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G004200200478481 OR 78483); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                        
G0043001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM,     PET follow ventriculogm mult1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G004300200478481 OR 78483); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR                                                                                                                                                                                                                                                   
G0043003004PHARMACOLOGIC)                                                                                                                                                                                                                                                                                                       
G0044001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); SINGLE STUDY,    PET following rest ECG singl1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0044002004REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                       
G0045001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); MULTIPLE         PET following rest ECG mult 1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0045002004STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                              
G0046001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); SINGLE STUDY,  PET follow stress ECG singl 1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0046002004REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                                       
G0047001003PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); MULTIPLE       PET follow stress ECG mult  1113    B50-36                                                                                                D                          I4A 4      0199501012005040120050331D                           
G0047002004STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)                                                                                                                                                                                                                                                              
G0050001003MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUNDResidual urine by ultrasound11      A                                                                            51798                    C                          I3F 4      0199601012003010120021231N                           
G0101001003CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION    CA screen;pelvic/breast exam11      A                                                                                                     D                      0064M1A 1      01998010119980101        N                           
G0102001003PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINATION                           Prostate ca screening; dre  11      A50-55             4182                                                                               D                      0079Y1  1      02000010120000101        N                           
G0103001003PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA), TOTAL          Psa, total screening        21      A50-55             4182                              310                                              D                      0079T1H 5      02000010120000101        N                           
G0104001003COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY                             CA screen;flexi sigmoidscope11      A                                                                                                     D                      0064P8C 2      01998010119980101        N                           
G0105001003COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK             Colorectal scrn; hi risk ind11      A                                                                                                     D0219980101            0064P8D 2      01998010119980101        N                           
G0106001003COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY,     Colon CA screen;barium enema11      A                                                                                                     D                      0064I1D 4      01998010119980101        N                           
G0106002004BARIUM ENEMA                                                                                                                                                                                                                                                                                                         
G0107001003COLORECTAL CANCER SCREENING; FECAL-OCCULT BLOOD TEST, 1-3 SIMULTANEOUS          CA screen; fecal blood test 21      A                                                                                                     D                      0064T1H 5      01998010119980101        N                           
G0107002004DETERMINATIONS                                                                                                                                                                                                                                                                                                       
G0108001003DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30       Diab manage trn  per indiv  11      A                                                                                                     C                      0071Y1  1      01998070120010101        N                           
G0108002004MINUTES                                                                                                                                                                                                                                                                                                              
G0109001003DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION (2 OR      Diab manage trn ind/group   11      A                                                                                                     C                      0071Y1  1      01998070120010101        N                           
G0109002004MORE), PER 30 MINUTES                                                                                                                                                                                                                                                                                                
G0110001003NETT PULM-REHAB; EDUCATION/SKILLS TRAINING, INDIVIDUAL                          Nett pulm-rehab educ; ind   11      A35-93                                                                                                D                      0065P6C 1      0199708012006010120051231D                           
G0111001003NETT PULM-REHAB; EDUCATION/SKILLS TRAINING, GROUP                               Nett pulm-rehab educ; group 11      A35-93                                                                                                D                      0065P6C 1      0199708012006010120051231D                           
G0112001003NETT PULM-REHAB; NUTRITIONAL GUIDANCE, INITIAL                                  Nett;nutrition guid, initial11      A35-93                                                                                                D                      0065P6C 1      0199708012006010120051231D                           
G0113001003NETT PULM-REHAB; NUTRITIONAL GUIDANCE, SUBSEQUENT                               Nett;nutrition guid,subseqnt11      A35-93                                                                                                D                      0065P6C 1      0199708012006010120051231D                           
G0114001003NETT PULM-REHAB; PSYCHOSOCIAL CONSULTATION                                      Nett; psychosocial consult  11      A35-93                                                                                                D                      0065Y1  3      0199708012006010120051231D                           
G0115001003NETT PULM-REHAB; PSYCHOLOGICAL TESTING                                          Nett; psychological testing 11      A35-93                                                                                                D                      0065Y1  1T     0199708012006010120051231D                           
G0116001003NETT PULM-REHAB; PSYCHOSOCIAL COUNSELLING                                       Nett; psychosocial counsel  11      A35-93                                                                                                D                      0065Y1  1T     0199708012006010120051231D                           
G0117001003GLAUCOMA SCREENING FOR HIGH RISK PATIENTS FURNISHED BY AN OPTOMETRIST OR        Glaucoma scrn hgh risk direc11      A                                                                                                     C                          T2D Q      02002010120031001        N                           
G0117002004OPHTHALMOLOGIST                                                                                                                                                                                                                                                                                                      
G0118001003GLAUCOMA SCREENING FOR HIGH RISK PATIENT FURNISHED UNDER THE DIRECT SUPERVISION Glaucoma scrn hgh risk direc11      A                                                                                                     C                          T2D Q      02002010120031001        N                           
G0118002004OF AN OPTOMETRIST OR OPHTHALOMOLOGIST                                                                                                                                                                                                                                                                                
G0120001003COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0105, SCREENING COLONOSCOPY,       Colon ca scrn; barium enema 11      A                                                                                                     D                      0064I1D 4      01998010119980101        N                           
G0120002004BARIUM ENEMA.                                                                                                                                                                                                                                                                                                        
G0121001003COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR Colon ca scrn not hi rsk ind11      A                                                                                                     D0220010701            0064I1D 2      01998010120010701        N                           
G0121002004HIGH RISK                                                                                                                                                                                                                                                                                                            
G0122001003COLORECTAL CANCER SCREENING; BARIUM ENEMA                                       Colon ca scrn; barium enema 00      9                                                                                                     M                      0064I1D 4      01998010119980101        N                           
G0123001003SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Screen cerv/vag thin layer  21      A50-20                                               630                                              D                      0045T1H 5      01998040119980401        N                           
G0123002004IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, SCREENING BY                                                                                                                                                                                                                                                
G0123003004CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                                         
G0124001003SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Screen c/v thin layer by MD 1121    C50-20                                               630                                              D                      0045T1H 5      01998040119980401        N                           
G0124002004IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, REQUIRING                                                                                                                                                                                                                                                   
G0124003004INTERPRETATION BY PHYSICIAN                                                                                                                                                                                                                                                                                          
G0125001003PET IMAGING REGIONAL OR WHOLE BODY; SINGLE PULMONARY NODULE                     PET image pulmonary nodule  11      A50-36             4173                                                                               D                          I2D 4      0199712182005040120050331D                           
G0127001003TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER                                        Trim nail(s)                11      A                  2323    4120                                                                       D                          P5A 2      01998010119980101        N                           
G0128001003DIRECT (FACE-TO-FACE WITH PATIENT) SKILLED NURSING SERVICES OF A REGISTERED     CORF skilled nursing service99      9                                          1833(a)                                                    D                      0070Y2  1      01998040119980401        N                           
G0128002004NURSE PROVIDED IN A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY, EACH 10                                                                                                                                                                                                                                        
G0128003004MINUTES BEYOND THE FIRST 5 MINUTES                                                                                                                                                                                                                                                                                   
G0129001003OCCUPATIONAL THERAPY REQUIRING THE SKILLS OF A QUALIFIED OCCUPATIONAL           Partial hosp prog service   00      9                                                                                                     C                      0087Y1  U      02000040120000401        N                           
G0129002004THERAPIST, FURNISHED AS A COMPONENT OF A PARTIAL HOSPITALIZATION TREATMENT                                                                                                                                                                                                                                           
G0129003004PROGRAM, PER DAY                                                                                                                                                                                                                                                                                                     
G0130001003SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DENSITY STUDY, ONE OR MORE       Single energy x-ray study   11      A50-44                                                                                                D                          I4B 4      01998070119980701        N                           
G0130002004SITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)                                                                                                                                                                                                                                                  
G0131001003COMPUTERIZED TOMOGRAPHY BONE MINERAL DENSITY STUDY, ONE OR MORE SITES; AXIAL    CT scan, bone density study 11      A50-44                                                                       76070                    D                          I2B 4      0199807012003010120021231N                           
G0131002004SKELETON (EG, HIPS, PELVIS, SPINE)                                                                                                                                                                                                                                                                                   
G0132001003COMPUTERIZED TOMOGRAPHY BONE MINERAL DENSITY STUDY, ONE OR MORE SITES;          CT scan, bone density study 11      A50-44                                                                       76071                    D                          I2B 4      0199807012003010120021231N                           
G0132002004APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)                                                                                                                                                                                                                                                         
G0141001003SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED     Scr c/v cyto,autosys and md 11      A                                                    630                                              C                      0045T1H 5      01999010119990101        N                           
G0141002004SYSTEM, WITH MANUAL RESCREENING, REQUIRING INTERPRETATION BY PHYSICIAN                                                                                                                                                                                                                                               
G0143001003SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5      01999010119990101        N                           
G0143002004IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH MANUAL SCREENING                                                                                                                                                                                                                                       
G0143003004AND RESCREENING BY CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                      
G0144001003SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5      01999010120030101        N                           
G0144002004IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH  SCREENING BY                                                                                                                                                                                                                                          
G0144003004AUTOMATED SYSTEM, UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                                        
G0145001003SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5      01999010120030101        N                           
G0145002004IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH  SCREENING BY                                                                                                                                                                                                                                          
G0145003004AUTOMATED SYSTEM AND MANUAL RESCREENING UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                  
G0147001003SCREENING CYTOPATHOLOGY SMEARS,  CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED    Scr c/v cyto, automated sys 21      A                                                    630                                              C                      0045T1H 5      01999010119990101        N                           
G0147002004SYSTEM UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                                                   
G0148001003SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED     Scr c/v cyto, autosys, rescr21      A                                                    630                                              C                      0045T1H 5      01999010119990101        N                           
G0148002004SYSTEM WITH MANUAL RESCREENING                                                                                                                                                                                                                                                                                       
G0151001003SERVICES OF PHYSICAL THERAPIST IN HOME HEALTH SETTING, EACH 15 MINUTES          HHCP-serv of pt,ea 15 min   00      9                                                                                                     C                      0082Y2  1      01999070119990701        N                           
G0152001003SERVICES OF OCCUPATIONAL THERAPIST IN HOME HEALTH SETTING, EACH 15 MINUTES      HHCP-serv of ot,ea 15 min   00      9                                                                                                     C                      0082Y2  1      01999070119990701        N                           
G0153001003SERVICES OF SPEECH AND LANGUAGE PATHOLOGIST IN HOME HEALTH SETTING, EACH 15     HHCP-svs of s/l path,ea 15mn00      9                                                                                                     C                      0082Y2  1      01999070119990701        N                           
G0153002004MINUTES                                                                                                                                                                                                                                                                                                              
G0154001003SERVICES OF SKILLED NURSE IN HOME HEALTH SETTING, EACH 15 MINUTES               HHCP-svs of rn,ea 15 min    00      9                                                                                                     C                      0082Y2  1      01999070119990701        N                           
G0155001003SERVICES OF CLINICAL SOCIAL WORKER IN HOME HEALTH SETTING, EACH 15 MINUTES      HHCP-svs of csw,ea 15 min   00      9                                                                                                     C                      0082Y2  1      01999070119990701        N                           
G0156001003SERVICES OF HOME HEALTH AIDE IN HOME HEALTH SETTING, EACH 15 MINUTES            HHCP-svs of aide,ea 15 min  00      9                                                                                                     C                      0082Y2  1      01999070119990701        N                           
G0166001003EXTERNAL COUNTERPULSATION, PER TREATMENT SESSION                                Extrnl counterpulse, per tx 11      A35-74                                                                                                D                      0078P6C 1      02000010120000101        N                           
G0167001003HYPERBARIC OXYGEN TREATMENT NOT REQUIRING PHYSICIAN ATTENDANCE, PER TREATMENT   Hyperbaric oz tx;no md reqrd11      A                                                                                                     G                          P6C 1      0200001012004010120031231N                           
G0167002004SESSION                                                                                                                                                                                                                                                                                                              
G0168001003WOUND CLOSURE UTILIZING TISSUE ADHESIVE(S) ONLY                                 Wound closure by adhesive   00      9                                                                                                     C                          P6C 1      02000010120000101        N                           
G0173001003LINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY, COMPLETE COURSE OF THERAPY  Linear acc stereo radsur com00      9                                                                                                     D                      0094P5E 2      02000080120050101        N                           
G0173002004IN ONE SESSION                                                                                                                                                                                                                                                                                                       
G0175001003SCHEDULED INTERDISCIPLINARY TEAM CONFERENCE (MINIMUM OF THREE EXCLUSIVE OF      OPPS Service,sched team conf00      9                                                                                                     C                      0101M6  1      02000070120000701        N                           
G0175002004PATIENT CARE NURSING STAFF) WITH PATIENT PRESENT                                                                                                                                                                                                                                                                     
G0176001003ACTIVITY THERAPY, SUCH AS MUSIC, DANCE, ART OR PLAY THERAPIES NOT FOR           OPPS/PHP;activity therapy   00      9                                                                                                     D                      0102Y2  U      02001010120010101        N                           
G0176002004RECREATION, RELATED TO THE CARE AND TREATMENT OF PATIENT'S DISABLING MENTAL                                                                                                                                                                                                                                          
G0176003004HEALTH PROBLEMS, PER SESSION (45 MINUTES OR MORE)                                                                                                                                                                                                                                                                    
G0177001003TRAINING AND EDUCATIONAL SERVICES RELATED TO THE CARE AND TREATMENT OF          OPPS/PHP; train & educ serv 00      9                                                                                                     D                      0102Y2  U      02001010120010101        N                           
G0177002004PATIENT'S DISABLING MENTAL HEALTH PROBLEMS PER SESSION (45 MINUTES OR MORE)                                                                                                                                                                                                                                          
G0179001003PHYSICIAN RE-CERTIFICATION FOR MEDICARE-COVERED HOME HEALTH  SERVICES UNDER A   MD recertification HHA PT   11      A                                                                                                     C                          Y1  1      02001010120010101        N                           
G0179002004HOME HEALTH PLAN OF CARE (PATIENT NOT PRESENT), INCLUDING CONTACTS WITH HOME                                                                                                                                                                                                                                         
G0179003004HEALTH AGENCY AND REVIEW OF REPORTS OF PATIENT STATUS REQUIRED BY PHYSICIANS TO                                                                                                                                                                                                                                      
G0179004004AFFIRM THE INITIAL IMPLEMENTATION OF THE PLAN OF CARE THAT MEETS PATIENT'S                                                                                                                                                                                                                                           
G0179005004NEEDS, PER RE-CERTIFICATION PERIOD                                                                                                                                                                                                                                                                                   
G0180001003PHYSICIAN CERTIFICATION FOR MEDICARE-COVERED HOME HEALTH  SERVICES UNDER A HOME MD certification HHA patient11      A                                                                                                     C                      0100Y1  1      02000100120001001        N                           
G0180002004HEALTH PLAN OF CARE (PATIENT NOT PRESENT), INCLUDING CONTACTS WITH HOME HEALTH                                                                                                                                                                                                                                       
G0180003004AGENCY AND REVIEW OF REPORTS OF PATIENT STATUS REQUIRED BY PHYSICIANS TO AFFIRM                                                                                                                                                                                                                                      
G0180004004THE INITIAL IMPLEMENTATION OF THE PLAN OF CARE THAT MEETS PATIENT'S NEEDS, PER                                                                                                                                                                                                                                       
G0180005004CERTIFICATION PERIOD                                                                                                                                                                                                                                                                                                 
G0181001003PHYSICIAN SUPERVISION OF A PATIENT RECEIVING MEDICARE-COVERED SERVICES PROVIDED Home health care supervision11      A                                                                                                     C                          Y1  1      02001010120010101        N                           
G0181002004BY A PARTICIPATING HOME HEALTH AGENCY (PATIENT NOT PRESENT) REQUIRING COMPLEX                                                                                                                                                                                                                                        
G0181003004AND MULTIDISCIPLINARY CARE MODALITIES INVOLVING REGULAR PHYSICIAN DEVELOPMENT                                                                                                                                                                                                                                        
G0181004004AND/OR REVISION OF CARE PLANS, REVIEW OF SUBSEQUENT REPORTS OF PATIENT STATUS,                                                                                                                                                                                                                                       
G0181005004REVIEW OF LABORATORY AND OTHER STUDIES, COMMUNICATION (INCLUDING TELEPHONE                                                                                                                                                                                                                                           
G0181006004CALLS) WITH OTHER HEALTH CARE PROFESSIONALS INVOLVED IN THE PATIENT'S CARE,                                                                                                                                                                                                                                          
G0181007004INTEGRATION OF NEW INFORMATION INTO THE MEDICAL TREATMENT PLAN AND/OR                                                                                                                                                                                                                                                
G0181008004ADJUSTMENT OF MEDICAL THERAPY, WITHIN A CALENDAR MONTH, 30 MINUTES OR MORE                                                                                                                                                                                                                                           
G0182001003PHYSICIAN SUPERVISION OF A PATIENT UNDER A MEDICARE-APPROVED HOSPICE (PATIENT   Hospice care supervision    11      A                                                                                                     C                          Y1  1      02001010120010101        N                           
G0182002004NOT PRESENT) REQUIRING COMPLEX AND MULTIDISCIPLINARY CARE MODALITIES INVOLVING                                                                                                                                                                                                                                       
G0182003004REGULAR PHYSICIAN DEVELOPMENT AND/OR REVISION OF CARE PLANS, REVIEW OF                                                                                                                                                                                                                                               
G0182004004SUBSEQUENT REPORTS OF PATIENT STATUS, REVIEW OF LABORATORY AND OTHER STUDIES,                                                                                                                                                                                                                                        
G0182005004COMMUNICATION (INCLUDING TELEPHONE CALLS) WITH OTHER HEALTH CARE PROFESSIONALS                                                                                                                                                                                                                                       
G0182006004INVOLVED IN THE PATIENT'S CARE, INTEGRATION OF NEW INFORMATION INTO THE MEDICAL                                                                                                                                                                                                                                      
G0182007004TREATMENT PLAN AND/OR ADJUSTMENT OF MEDICAL THERAPY, WITHIN A CALENDAR MONTH,                                                                                                                                                                                                                                        
G018200800430 MINUTES OR MORE                                                                                                                                                                                                                                                                                                   
G0185001003DESTRUCTION OF LOCALIZED LESION OF CHOROID (FOR EXAMPLE, CHOROIDAL              Transpuppillary thermotx    00      9                                                                            0016T                    C                      0099P4D 2      0200101012003010120021231N                           
G0185002004NEOVASCULARIZATION); TRANSPUPILLARY THERMOTHERAPY (ONE OR MORE SESSIONS)                                                                                                                                                                                                                                             
G0186001003DESTRUCTION OF LOCALIZED LESION OF CHOROID (FOR EXAMPLE, CHOROIDAL              Dstry eye lesn,fdr vssl tech00      9                                                                                                     C                      0099P4D 2      02001010120010101        N                           
G0186002004NEOVASCULARIZATION); PHOTOCOAGULATION, FEEDER VESSEL TECHNIQUE (ONE OR MORE                                                                                                                                                                                                                                          
G0186003004SESSIONS)                                                                                                                                                                                                                                                                                                            
G0187001003DESTRUCTION OF MACULAR DRUSEN, PHOTOCOAGULATION (ONE OR MORE SESSIONS)          Dstry mclr drusen,photocoag 00      9                                                                                                     C                      0099P4D 2      0200101012003010120021231N                           
G0192001003INTRANASAL OR ORAL ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION           Immunization oral/intranasal00      9                  2049.4  2320                                                                       M                          P6C 1      0200101012003010120021231N                           
G0192002004VACCINE/TOXOID)                                                                                                                                                                                                                                                                                                      
G0193001003ENDOSCOPIC STUDY OF SWALLOWING FUNCTION (ALSO FIBEROPTIC ENDOSCOPIC EVALUATION  Endoscopicstudyswallowfunctn11      A                                                                            92612                    C                          Y1  1      0200101012003010120021231N                           
G0193002004OF SWALLOWING (FEES)                                                                                                                                                                                                                                                                                                 
G0194001003SENSORY TESTING DURING ENDOSCOPIC STUDY OF SWALLOWING (ADD ON CODE)  REFERRED   Sensorytestingendoscopicstud11      A                                                                            92614                    C                          Y1  1      0200101012003010120021231N                           
G0194002004TO AS FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING WITH SENSORY TESTING                                                                                                                                                                                                                                            
G0194003004(FEEST)                                                                                                                                                                                                                                                                                                              
G0195001003CLINICAL EVALUATION OF SWALLOWING FUNCTION (NOT INVOLVING INTERPRETATION OF     Clinicalevalswallowingfunct 11      A                                                                            92610                    C                          Y1  1      0200101012003010120021231N                           
G0195002004DYNAMIC RADIOLOGICAL STUDIES OR ENDOSCOPIC STUDY OF SWALLOWING)                                                                                                                                                                                                                                                      
G0196001003EVALUATION OF SWALLOWING INVOLVING SWALLOWING OF RADIO-OPAQUE MATERIALS         Evalofswallowingwithradioopa11      A                                                                            92611                    C                          Y1  1      0200101012003010120021231N                           
G0197001003EVALUATION OF PATIENT FOR PRESCRIPTION OF SPEECH GENERATING DEVICES             Evalofptforprescipspeechdevi11      A                                                                            92607                    C                          Y1  1      0200101012003010120021231N                           
G0198001003PATIENT ADAPTATION AND TRAINING FOR USE OF SPEECH GENERATING DEVICES            Patientadapation&trainforspe11      A                                                                            92609                    C                          Y1  1      0200101012003010120021231N                           
G0199001003RE-EVALUATION OF PATIENT USING SPEECH GENERATING DEVICES                        Reevaluationofpatientusespec11      A                                                                            9260792608               C                          Y1  1      0200101012003010120021231N                           
G0200001003EVALUATION OF PATIENT FOR PRESCRIPTION OF VOICE PROSTHETIC                      Evalofpatientprescipofvoicep11      A                                                                            92506                    C                          Y1  1      0200101012003010120021231N                           
G0201001003MODIFICATION OR TRAINING IN USE OF VOICE PROSTHETIC                             Modifortraininginusevoicepro11      A                                                                            92507                    C                          Y1  1      0200101012003010120021231N                           
G0202001003SCREENING MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS     Screeningmammographydigital 11      A                                                                                                     C                          I1C 1      02001040120010401        N                           
G0204001003DIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS    Diagnosticmammographydigital11      A                                                                                                     C                          I1C 4      02001040120030101        N                           
G0206001003DIAGNOSTIC MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, UNILATERAL, ALL VIEWS   Diagnosticmammographydigital11      A                                                                                                     C                          I1C 4      02001040120030101        N                           
G0210001003PET IMAGING WHOLE BODY; DIAGNOSIS; LUNG CANCER, NON-SMALL CELL                  PET img wholebody dxlung    11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0211001003PET IMAGING WHOLE BODY; INITIAL STAGING; LUNG CANCER; NON-SMALL CELL (REPLACES  PET img wholbody init lung  11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0211002004G0126)                                                                                                                                                                                                                                                                                                               
G0212001003PET IMAGING WHOLE BODY; RESTAGING; LUNG CANCER; NON-SMALL                       PET img wholebod restag lung11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0213001003PET IMAGING WHOLE BODY; DIAGNOSIS; COLORECTAL                                   PET img wholbody dx         11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0214001003PET IMAGING WHOLE BODY; INITIAL STAGING; COLORECTAL                             PET img wholebod init       11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0215001003PET IMAGING WHOLE BODY; RESTAGING; COLORECTAL CANCER (REPLACES G0163)           PETimg wholebod restag      11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0216001003PET IMAGING WHOLE BODY; DIAGNOSIS; MELANOMA                                     PET img wholebod dx melanoma11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0217001003PET IMAGING WHOLE BODY; INITIAL STAGING; MELANOMA                               PET img wholebod init melan 11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0218001003PET IMAGING WHOLE BODY; RESTAGING; MELANOMA (REPLACES G0165)                    PET img wholebod restag mela11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0219001003PET IMAGING WHOLE BODY; MELANOMA FOR NON-COVERED INDICATIONS                    PET img wholbod melano nonco00      950-36             4173                                                                               M                          I4B 4      02001070120010701        N                           
G0220001003PET IMAGING WHOLE BODY; DIAGNOSIS; LYMPHOMA                                     PET img wholebod dx lymphoma11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0221001003PET IMAGING WHOLE BODY; INITIAL STAGING; LYMPHOMA (REPLACES G0164)              PET imag wholbod init lympho11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0222001003PET IMAGING WHOLE BODY; RESTAGING; LYMPHOMA (REPLACES G0164)                    PET imag wholbod resta lymph11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0223001003PET IMAGING WHOLE BODY OR REGIONAL; DIAGNOSIS; HEAD AND NECK CANCER; EXCLUDING  PET imag wholbod reg dx head11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0223002004THYROID AND CNS CANCERS                                                                                                                                                                                                                                                                                              
G0224001003PET IMAGING WHOLE BODY OR REGIONAL; INITIAL STAGING; HEAD AND NECK CANCER;      PET imag wholbod reg ini hea11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0224002004EXCLUDING THYROID AND CNS CANCERS                                                                                                                                                                                                                                                                                    
G0225001003PET IMAGING WHOLE BODY OR REGIONAL; RESTAGING; HEAD AND NECK CANCER, EXCLUDING  PET whol restag headneckonly11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0225002004THYROID AND CNS CANCERS                                                                                                                                                                                                                                                                                              
G0226001003PET IMAGING WHOLE BODY; DIAGNOSIS; ESOPHAGEAL CANCER                            PET img wholbody dx esophagl11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0227001003PET IMAGING WHOLE BODY; INITIAL STAGING; ESOPHAGEAL CANCER                      PET img wholbod ini esophage11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0228001003PET IMAGING WHOLE BODY; RESTAGING; ESOPHAGEAL CANCER                            PET img wholbod restg esopha11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0229001003PET IMAGING; METABOLIC BRAIN IMAGING FOR PRE-SURGICAL EVALUATION OF REFRACTORY  PET img metaboloc brain pres11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0229002004SEIZURES                                                                                                                                                                                                                                                                                                             
G0230001003PET IMAGING; METABOLIC ASSESSMENT FOR MYOCARDIAL VIABILITY FOLLOWING            PET myocard viability post  11      A50-36             4173                                                                               D                          I4B 4      0200107012005040120050331D                           
G0230002004INCONCLUSIVE SPECT  STUDY                                                                                                                                                                                                                                                                                            
G0231001003PET, WHOLE BODY, FOR RECURRENCE OF COLORECTAL OR COLORECTAL METASTATIC CANCER;  PET WhBD colorec; gamma cam 11      A50-36                                                                                                D                          I4B 4      0200201012005040120050331D                           
G0231002004GAMMA CAMERAS ONLY                                                                                                                                                                                                                                                                                                   
G0232001003PET, WHOLE BODY, FOR STAGING AND CHARACTERIZATION OF LYMPHOMA; GAMMA CAMERAS    PET whbd lymphoma; gamma cam11      A50-36                                                                                                D                          I4B 4      0200201012005040120050331D                           
G0232002004ONLY                                                                                                                                                                                                                                                                                                                 
G0233001003PET, WHOLE BODY, FOR RECURRENCE OF MELANOMA OR MELANOMA METASTATIC CANCER;      PET whbd melanoma; gamma cam11      A50-36                                                                                                D                          I4B 4      0200201012005040120050331D                           
G0233002004GAMMA CAMERAS ONLY                                                                                                                                                                                                                                                                                                   
G0234001003PET, REGIONAL OR WHOLE BODY, FOR SOLITARY PULMONARY NODULE FOLLOWING CT OR FOR  PET WhBD pulm nod; gamma cam11      A50-36                                                                                                D                          I4B 4      0200201012005040120050331D                           
G0234002004INITIAL STAGING OF PATHOLOGICALLY DIAGNOSED NONSMALL CELL LUNG CANCER; GAMMA                                                                                                                                                                                                                                         
G0234003004CAMERAS ONLY                                                                                                                                                                                                                                                                                                         
G0235001003PET IMAGING, ANY SITE, NOT OTHERWISE SPECIFIED                                  PET not otherwise specified 00      950-36                                                                                                M                          T2D 1      02006010120060101        A                           
G0236001003DIGITIZATION OF FILM RADIOGRAPHIC IMAGES WITH COMPUTER ANALYSIS FOR LESION      Digital film convert diag ma11      A                                                                                                     C                          I4B 4      0200201012004010120031231N                           
G0236002004DETECTION, OR COMPUTER ANALYSIS OF DIGITAL MAMMOGRAM FOR LESION DETECTION, AND                                                                                                                                                                                                                                       
G0236003004FURTHER PHYSICIAN REVIEW FOR INTERPRETATION, DIAGNOSTIC MAMMOGRAPHY (LIST                                                                                                                                                                                                                                            
G0236004004SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                
G0237001003THERAPEUTIC PROCEDURES TO INCREASE STRENGTH OR ENDURANCE OF RESPIRATORY         Therapeutic procd strg endur11      A                                                                                                     C                          P6C 1UW    02002010120041001        N                           
G0237002004MUSCLES, FACE TO FACE, ONE ON ONE, EACH 15 MINUTES (INCLUDES MONITORING)                                                                                                                                                                                                                                             
G0238001003THERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY FUNCTION, OTHER THAN DESCRIBED BY Oth resp proc, indiv        11      A                                                                                                     C                          P6C 1UW    02002010120041001        N                           
G0238002004G0237, ONE ON ONE, FACE TO FACE, PER 15 MINUTES (INCLUDES MONITORING)                                                                                                                                                                                                                                                
G0239001003THERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY FUNCTION OR INCREASE STRENGTH OR  Oth resp proc, group        11      A                                                                                                     C                          P6C 1UW    02002010120041001        N                           
G0239002004ENDURANCE OF RESPIRATORY MUSCLES, TWO OR MORE INDIVIDUALS (INCLUDES MONITORING)                                                                                                                                                                                                                                      
G0240001003CRITICAL CARE SERVICE DELIVERED BY A PHYSICIAN, FACE TO FACE; DURING            Critic care by MD transport 11      A                                                                                                     C                          O1A 1      0200201012003010120021231N                           
G0240002004INTERFACILITY TRANSPORT OF A CRITICALLY ILL OR CRITICALLY INJURED PATIENT;                                                                                                                                                                                                                                           
G0240003004FIRST 30-74 MINUTES OF ACTIVE TRANSPORT                                                                                                                                                                                                                                                                              
G0241001003EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO G0240)               Each additional 30 minutes  11      A                                                                                                     C                          O1A 1      0200201012003010120021231N                           
G0242001003MULTI-SOURCE PHOTON STEREOTACTIC RADIOSURGERY (COBALT 60 MULTI-SOURCE           Multisource photon ster plan00      9                                                                                                     D                      0094P5E 2      0200201012006010120051231D                           
G0242002004CONVERGING BEAMS) PLAN, INCLUDING DOSE VOLUME HISTOGRAMS FOR TARGET AND                                                                                                                                                                                                                                              
G0242003004CRITICAL STRUCTURE TOLERANCES, PLAN OPTIMIZATION PERFORMED FOR HIGHLY CONFORMAL                                                                                                                                                                                                                                      
G0242004004DISTRIBUTIONS, PLAN POSITIONAL ACCURACY AND DOSE VERIFICATION, ALL LESIONS                                                                                                                                                                                                                                           
G0242005004TREATED, PER COURSE OF TREATMENT                                                                                                                                                                                                                                                                                     
G0243001003MULTI-SOURCE PHOTON STEREOTACTIC RADIOSURGERY, DELIVERY INCLUDING COLLIMATOR    Multisour photon stero treat00      9                                                                                                     D                      0094P5E 2      02002010120020101        N                           
G0243002004CHANGES AND CUSTOM PLUGGING, COMPLETE COURSE OF TREATMENT, ALL LESIONS                                                                                                                                                                                                                                               
G0244001003OBSERVATION CARE PROVIDED BY A FACILITY TO A PATIENT WITH CHF, CHEST PAIN, OR   Observ care by facility topt00      9                                                                                                     D                      0107M2A 1      0200201012006010120051231D                           
G0244002004ASTHMA, MINIMUM EIGHT HOURS                                                                                                                                                                                                                                                                                          
G0245001003INITIAL PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH DIABETIC Initial foot exam pt lops   11      A50.81                                                                                                D                          M1A 1      02002070120020701        N                           
G0245002004SENSORY NEUROPATHY RESULTING IN A LOSS OF PROTECTIVE SENSATION (LOPS) WHICH                                                                                                                                                                                                                                          
G0245003004MUST INCLUDE: (1) THE DIAGNOSIS OF LOPS, (2) A PATIENT HISTORY, (3) A PHYSICAL                                                                                                                                                                                                                                       
G0245004004EXAMINATION THAT CONSISTS OF AT LEAST THE FOLLOWING ELEMENTS: (A) VISUAL                                                                                                                                                                                                                                             
G0245005004INSPECTION OF THE FOREFOOT, HINDFOOT AND TOE WEB SPACES, (B)EVALUATION OF A                                                                                                                                                                                                                                          
G0245006004PROTECTIVE SENSATION, (C) EVALUATION OF FOOT STRUCTURE AND BIOMECHANICS, (D)                                                                                                                                                                                                                                         
G0245007004EVALUATION OF VASCULAR STATUS AND SKIN INTEGRITY, AND (E) EVALUATION AND                                                                                                                                                                                                                                             
G0245008004RECOMMENDATION OF FOOTWEAR AND (4) PATIENT EDUCATION                                                                                                                                                                                                                                                                 
G0246001003FOLLOW-UP PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH        Followup eval of foot pt lop11      A50.81                                                                                                D                          M1B 1      02002070120020701        N                           
G0246002004DIABETIC SENSORY NEUROPATHY RESULTING IN A LOSS OF PROTECTIVE SENSATION (LOPS)                                                                                                                                                                                                                                       
G0246003004TO INCLUDE AT LEAST THE FOLLOWING: (1) A PATIENT HISTORY, (2) A PHYSICAL                                                                                                                                                                                                                                             
G0246004004EXAMINATION THAT INCLUDES: (A) VISUAL INSPECTION OF THE FOREFOOT, HINDFOOT AND                                                                                                                                                                                                                                       
G0246005004TOE WEB SPACES, (B) EVALUATION OF PROTECTIVE SENSATION, (C) EVALUATION OF FOOT                                                                                                                                                                                                                                       
G0246006004STRUCTURE AND BIOMECHANICS, (D) EVALUATION OF VASCULAR STATUS AND SKIN                                                                                                                                                                                                                                               
G0246007004INTEGRITY, AND (E) EVALUATION AND RECOMMENDATION OF FOOTWEAR, AND (3) PATIENT                                                                                                                                                                                                                                        
G0246008004EDUCATION                                                                                                                                                                                                                                                                                                            
G0247001003ROUTINE FOOT CARE BY A PHYSICIAN OF A DIABETIC PATIENT WITH DIABETIC SENSORY    Routine footcare pt w lops  11      A50.81                                                                                                D                          M1B 1      02002070120030701        N                           
G0247002004NEUROPATHY RESULTING IN A LOSS OF PROTECTIVE SENSATION (LOPS) TO INCLUDE, THE                                                                                                                                                                                                                                        
G0247003004LOCAL CARE OF SUPERFICIAL WOUNDS (I.E. SUPERFICIAL TO MUSCLE AND FASCIA) AND AT                                                                                                                                                                                                                                      
G0247004004LEAST THE FOLLOWING IF PRESENT: (1) LOCAL CARE OF SUPERFICIAL WOUNDS, (2)                                                                                                                                                                                                                                            
G0247005004DEBRIDEMENT OF CORNS AND CALLUSES, AND (3) TRIMMING AND DEBRIDEMENT OF NAILS                                                                                                                                                                                                                                         
G0248001003DEMONSTRATION, AT INITIAL USE, OF HOME INR MONITORING FOR PATIENT WITH          Demonstrate use home inr mon11      A50.55                                                                                                D                          M1A 5      02002070120020701        N                           
G0248002004MECHANICAL HEART VALVE(S) WHO MEETS MEDICARE COVERAGE CRITERIA, UNDER THE                                                                                                                                                                                                                                            
G0248003004DIRECTION OF A PHYSICIAN; INCLUDES: DEMONSTRATING USE AND CARE OF THE INR                                                                                                                                                                                                                                            
G0248004004MONITOR, OBTAINING AT LEAST ONE BLOOD SAMPLE, PROVISION OF INSTRUCTIONS FOR                                                                                                                                                                                                                                          
G0248005004REPORTING HOME INR TEST RESULTS, AND DOCUMENTATION OF PATIENT ABILITY TO                                                                                                                                                                                                                                             
G0248006004PERFORM TESTING                                                                                                                                                                                                                                                                                                      
G0249001003PROVISION OF TEST MATERIALS AND EQUIPMENT FOR HOME INR MONITORING TO PATIENT    Provide test material,equipm11      A50.55                                                                                                D                          Y1  5      02002070120020701        N                           
G0249002004WITH MECHANICAL HEART VALVE(S) WHO MEETS MEDICARE COVERAGE CRITERIA; INCLUDES                                                                                                                                                                                                                                        
G0249003004PROVISION OF MATERIALS FOR USE IN THE HOME AND REPORTING OF TEST RESULTS TO                                                                                                                                                                                                                                          
G0249004004PHYSICIAN; PER 4 TESTS                                                                                                                                                                                                                                                                                               
G0250001003PHYSICIAN REVIEW, INTERPRETATION AND PATIENT MANAGEMENT OF HOME INR TESTING FOR MD review interpret of test 11      A50.55                                                                                                D                          M1B 1      02002070120020701        N                           
G0250002004A PATIENT WITH MECHANICAL HEART VALVE(S) WHO MEETS OTHER COVERAGE CRITERIA; PER                                                                                                                                                                                                                                      
G02500030044 TESTS (DOES NOT REQUIRE FACE-TO-FACE SERVICE)                                                                                                                                                                                                                                                                      
G0251001003LINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY, DELIVERY INCLUDING          Linear acc based stero radio00      9                                                                                                     D                      0107I1F 4      02002040120020401        N                           
G0251002004COLLIMATOR CHANGES AND CUSTOM PLUGGING, FRACTIONATED TREATMENT, ALL LESIONS,                                                                                                                                                                                                                                         
G0251003004PER SESSION, MAXIMUM FIVE SESSIONS PER COURSE OF TREATMENT                                                                                                                                                                                                                                                           
G0252001003PET IMAGING, FULL AND PARTIAL-RING PET SCANNERS ONLY, FOR INITIAL DIAGNOSIS OF  PET imaging initial dx      00      950-36                                                                                                M                          I2D 4      0200210012005040120050331D                           
G0252002004BREAST CANCER AND/OR SURGICAL PLANNING FOR BREAST CANCER (E.G. INITIAL STAGING                                                                                                                                                                                                                                       
G0252003004OF AXILLARY LYMPH NODES)                                                                                                                                                                                                                                                                                             
G0253001003PET IMAGING FOR BREAST CANCER, FULL AND PARTIAL-RING PET SCANNERS ONLY,         PET image brst dection recur11      A50-36                                                                                                C                          I2D 4      0200210012005040120050331D                           
G0253002004STAGING/RESTAGING OF LOCAL REGIONAL RECURRENCE OR DISTANT METASTASES (I.E.,                                                                                                                                                                                                                                          
G0253003004STAGING/RESTAGING AFTER OR PRIOR TO COURSE OF TREATMENT)                                                                                                                                                                                                                                                             
G0254001003PET IMAGING FOR BREAST CANCER, FULL AND PARTIAL- RING PET SCANNERS ONLY,        PET image brst eval to tx   11      A50-36                                                                                                C                          I1C 4      0200210012005040120050331D                           
G0254002004EVALUATION OF RESPONSE TO TREATMENT, PERFORMED DURING COURSE OF TREATMENT                                                                                                                                                                                                                                            
G0255001003CURRENT PERCEPTION THRESHOLD/SENSORY NERVE CONDUCTION TEST, (SNCT) PER LIMB,    Current percep threshold tst00      950-57                                                                                                M                          T2D 4      02002100120021001        N                           
G0255002004ANY NERVE                                                                                                                                                                                                                                                                                                            
G0256001003PROSTATE BRACHYTHERAPY USING PERMANENTLY IMPLANTED PALLADIUM SEEDS, INCLUDING   Prostate brachy w palladium 00      9                                                                                                     D                      0107P1G 2      0200301012004010120031231N                           
G0256002004TRANSPERITONEAL PLACEMENT OF NEEDLES OR CATHETERS INTO THE PROSTATE, CYSTOSCOPY                                                                                                                                                                                                                                      
G0256003004AND APPLICATION OF PERMANENT INTERSTITIAL RADIATION SOURCE                                                                                                                                                                                                                                                           
G0257001003UNSCHEDULED OR EMERGENCY DIALYSIS TREATMENT FOR AN ESRD PATIENT IN A HOSPITAL   Unsched dialysis ESRD pt hos00      9                                                                                                     D                      0107P6D 1      02003010120030101        N                           
G0257002004OUTPATIENT DEPARTMENT THAT IS NOT CERTIFIED AS AN ESRD FACILITY                                                                                                                                                                                                                                                      
G0258001003INTRAVENOUS INFUSION DURING SEPARATELY PAYABLE OBSERVATION STAY, PER            IV infusion during obs stay 00      9                                                                                                     D                      0107O1C 1      0200204012006010120051231D                           
G0258002004OBSERVATION STAY (MUST BE REPORTED WITH G0244)                                                                                                                                                                                                                                                                       
G0259001003INJECTION PROCEDURE FOR SACROILIAC JOINT; ARTHROGRAPY                           Inject for sacroiliac joint 00      9                                                                                                     D                      0107O1E 1      02003010120030101        N                           
G0260001003INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID      Inj for sacroiliac jt anesth00      9                                                                                                     D                      0107O1E F      02003010120041001        N                           
G0260002004AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY                                                                                                                                                                                                                                                         
G0261001003PROSTATE BRACHYTHERAPY USING PERMANENTLY IMPLANTED IODINE SEEDS, INCLUDING      Prostate brachy w iodine see00      9                                                                                                     D                      0107P1G 2      0200301012004010120031231N                           
G0261002004TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO THE PROSTATE, CYSTOSCOPY                                                                                                                                                                                                                                        
G0261003004AND APPLICATION OF PERMANENT INTERSTITIAL RADIATION SOURCE                                                                                                                                                                                                                                                           
G0262001003SMALL INTESTINAL IMAGING; INTRALUMINAL, FROM LIGAMENT OF TREITZ TO THE ILEO     Sm intestinal image capsule 11      A                                                                                                     G                          I4B 4      0200301012004010120031231N                           
G0262002004CECAL VALVE, INCLUDES PHYSICIAN INTERPRETATION AND REPORT                                                                                                                                                                                                                                                            
G0263001003DIRECT ADMISSION OF PATIENT WITH DIAGNOSIS OF CONGESTIVE HEART FAILURE, CHEST   Adm with CHF, CP, asthma    00      9                                                                                                     D                      0107M3  1      0200301012006010120051231D                           
G0263002004PAIN OR ASTHMA FOR OBSERVATION SERVICES THAT MEET ALL CRITERIA FOR G0244                                                                                                                                                                                                                                             
G0264001003INITIAL NURSING ASSESSMENT OF PATIENT DIRECTLY ADMITTED TO OBSERVATION WITH     Assmt otr CHF, CP, asthma   00      9                                                                                                     D                      0107M3  1      0200301012006010120051231D                           
G0264002004DIAGNOSIS OTHER THAN CHF, CHEST PAIN OR ASTHMA OR PATIENT DIRECTLY ADMITTED TO                                                                                                                                                                                                                                       
G0264003004OBSERVATION WITH DIAGNOSIS OF CHF, CHEST PAIN OR ASTHMA WHEN THE OBSERVATION                                                                                                                                                                                                                                         
G0264004004STAY DOES NOT QUALIFY FOR G0244                                                                                                                                                                                                                                                                                      
G0265001003CRYOPRESERVATION, FREEZING AND STORAGE OF CELLS FOR THERAPEUTIC USE, EACH CELL  Cryopresevation Freeze+stora13      A                                                                                                     C                          T1H 5      02003010120030101        N                           
G0265002004LINE                                                                                                                                                                                                                                                                                                                 
G0266001003THAWING AND EXPANSION OF FROZEN CELLS FOR THERAPEUTIC USE, EACH ALIQUOT         Thawing + expansion froz cel11      A                                                                                                     C                          T1H 5      02003010120030101        N                           
G0267001003BONE MARROW OR PERIPHERAL STEM CELL HARVEST, MODIFICATION OR TREATMENT TO       Bone marrow or psc harvest  11      A                                                                                                     C                          T1H 5      02003010120030101        N                           
G0267002004ELIMINATE CELL TYPE(S) (E.G. T-CELLS, METASTATIC CARCINOMA)                                                                                                                                                                                                                                                          
G0268001003REMOVAL OF IMPACTED CERUMEN (ONE OR BOTH EARS) BY PHYSICIAN ON SAME DATE OF     Removal of impacted wax md  11      A                                                                                                     C                          P6C 2      02003010120030101        N                           
G0268002004SERVICE AS AUDIOLOGIC FUNCTION TESTING                                                                                                                                                                                                                                                                               
G0269001003PLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR ARTERIAL ACCESS SITE,     Occlusive device in vein art00      9                                                                                                     D                      0108P6D 1      02003010120030101        N                           
G0269002004POST SURGICAL OR INTERVENTIONAL PROCEDURE (E.G. ANGIOSEAL PLUG, VASCULAR PLUG)                                                                                                                                                                                                                                       
G0270001003MEDICAL NUTRITION THERAPY; REASSESSMENT AND SUBSEQUENT INTERVENTION(S)          MNT subs tx for change dx   11      A                                                                                                     C                          M5D 1      02003010120030101        N                           
G0270002004FOLLOWING SECOND REFERRAL IN SAME YEAR FOR CHANGE IN DIAGNOSIS, MEDICAL                                                                                                                                                                                                                                              
G0270003004CONDITION OR TREATMENT REGIMEN (INCLUDING ADDITIONAL HOURS NEEDED FOR RENAL                                                                                                                                                                                                                                          
G0270004004DISEASE), INDIVIDUAL, FACE TO FACE WITH THE PATIENT, EACH 15 MINUTES                                                                                                                                                                                                                                                 
G0271001003MEDICAL NUTRITION THERAPY, REASSESSMENT AND SUBSEQUENT INTERVENTION(S)          Group MNT 2 or more 30 mins 11      A                                                                                                     C                          M5D 1      02003010120030101        N                           
G0271002004FOLLOWING SECOND REFERRAL IN SAME YEAR FOR CHANGE IN DIAGNOSIS, MEDICAL                                                                                                                                                                                                                                              
G0271003004CONDITION, OR TREATMENT REGIMEN (INCLUDING ADDITIONAL HOURS NEEDED FOR RENAL                                                                                                                                                                                                                                         
G0271004004DISEASE), GROUP (2 OR MORE INDIVIDUALS), EACH 30 MINUTES                                                                                                                                                                                                                                                             
G0272001003NASO/ORO GASTRIC TUBE PLACEMENT, REQUIRING PHYSICIAN'S SKILL AND FLUOROSCOPIC   Naso/oro gastric tube pl MD 11      A                                                                                                     G                          P6C 1      0200301012004010120031231N                           
G0272002004GUIDANCE (INCLUDES FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT)                                                                                                                                                                                                                                                      
G0273001003RADIOPHARMACEUTICAL BIODISTRIBUTION, SINGLE OR MULTIPLE SCANS ON ONE OR MORE    Pretx planning, non-Hodgkins11      A                                                                                                     G                          I1E 6      0200301012004010120031231N                           
G0273002004DAYS, PRE-TREATMENT PLANNING FOR RADIOPHARMACEUTICAL THERAPY OF NON-HODGKIN'S                                                                                                                                                                                                                                        
G0273003004LYMPHOMA, INCLUDES ADMINISTRATION OF RADIOPHARMACEUTICAL (E.G., RADIOLABELED                                                                                                                                                                                                                                         
G0273004004ANTIBODIES)                                                                                                                                                                                                                                                                                                          
G0274001003RADIOPHARMACEUTICAL THERAPY, NON-HODGKIN'S LYMPHOMA, INCLUDES ADMINISTRATION OF Radiopharm tx, non-Hodgkins 11      A                                                                                                     G                          I1E 6      0200301012004010120031231N                           
G0274002004RADIOPHARMACEUTICAL (.E.G. RADIOLABELED ANTIBODIES)                                                                                                                                                                                                                                                                  
G0275001003RENAL ARTERY ANGIOGRAPHY (UNILATERAL OR BILATERAL) PERFORMED AT THE TIME OF     Renal angio, cardiac cath   11      A                                                                                                     C                          I4A 2      02003010120030101        N                           
G0275002004CARDIAC CATHETERIZATION, INCLUDES CATHETER PLACEMENT, INJECTION OF DYE, FLUSH                                                                                                                                                                                                                                        
G0275003004AORTOGRAM AND RADIOLOGIC SUPERVISION AND INTERPRETATION AND PRODUCTION OF                                                                                                                                                                                                                                            
G0275004004IMAGES (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE)                                                                                                                                                                                                                                                            
G0278001003ILIAC ARTERY ANGIOGRAPHY PERFORMED AT THE SAME TIME OF CARDIAC CATHETERIZATION, Iliac art angio,cardiac cath11      A                                                                                                     C                          I4A 2      02003010120030101        N                           
G0278002004INCLUDES CATHETER PLACEMENT, INJECTION OF DYE, RADIOLOGIC SUPERVISION AND                                                                                                                                                                                                                                            
G0278003004INTERPRETATION AND PRODUCTION OF IMAGES  (LIST SEPARATELY IN ADDITION TO                                                                                                                                                                                                                                             
G0278004004PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                                   
G0279001003EXTRACORPOREAL SHOCK WAVE THERAPY; INVOLVING ELBOW EPICONDYLITIS                Excorp shock tx, elbow epi  11      A                                                                                                     C                          T2D 1UW    0200301012006010120051231D                           
G0280001003EXTRACORPOREAL SHOCK WAVE THERAPY; INVOLVING OTHER THAN ELBOW EPICONDYLITIS OR  Excorp shock tx other than  11      A                                                                                                     C                          T2D 1UW    0200301012006010120051231D                           
G0280002004PLANTAR FASCITIS                                                                                                                                                                                                                                                                                                     
G0281001003ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR CHRONIC STAGE   Elec stim unattend for press11      A                                                                                                     C                          P5E 1UW    02003040120030401        N                           
G0281002004III AND STAGE IV PRESSURE ULCERS, ARTERIAL ULCERS, DIABETIC ULCERS, AND VENOUS                                                                                                                                                                                                                                       
G0281003004STATSIS ULCERS NOT DEMONSTRATING MEASURABLE SIGNS OF HEALING AFTER 30 DAYS OF                                                                                                                                                                                                                                        
G0281004004CONVENTIONAL CARE, AS PART OF A THERAPY PLAN OF CARE                                                                                                                                                                                                                                                                 
G0282001003ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE      Elect stim wound care not pd00      9                  35-98                                                                              M                          P5E 1UW    02003040120030401        N                           
G0282002004OTHER THAN DESCRIBED IN G0281                                                                                                                                                                                                                                                                                        
G0283001003ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S)     Elec stim other than wound  11      A                                                                                                     C                          P5E 1UW    02003010120030101        N                           
G0283002004OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE                                                                                                                                                                                                                                                             
G0288001003RECONSTRUCTION, COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF AORTA FOR SURGICAL PLANNING Recon, CTA for surg plan    11      A                                                                                                     C                          I2B 1      02003010120030101        N                           
G0288002004FOR VASCULAR SURGERY                                                                                                                                                                                                                                                                                                 
G0289001003ARTHROSCOPY, KNEE, SURGICAL, FOR REMOVAL OF LOOSE BODY, FOREIGN BODY,           Arthro, loose body + chondro11      A                                                                                                     C                          P8A 2      02003010120030101        N                           
G0289002004DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHRONDROPLASTY) AT THE TIME OF                                                                                                                                                                                                                                           
G0289003004OTHER SURGICAL KNEE ARTHROSCOPY IN A DIFFERENT COMPARTMENT OF THE SAME KNEE                                                                                                                                                                                                                                          
G0290001003TRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS, Drug-eluting stents, single 00      9                                                                                                     D                      0107P2D 2      02003010120030101        N                           
G0290002004WITH OR WITHOUT OTHER THERAPEUTIC INTERVENTION, ANY METHOD; SINGLE VESSEL                                                                                                                                                                                                                                            
G0291001003TRANSCATHETER PLACEMENT OF A DRUG ELUTING INTRACORONARY STENT(S), PERCUTANEOUS, Drug-eluting stents,each add00      9                                                                                                     D                      0107P2D 2      02003010120030101        N                           
G0291002004WITH OR WITHOUT OTHER THERAPEUTIC INTERVENTION, ANY METHOD; EACH ADDITIONAL                                                                                                                                                                                                                                          
G0291003004VESSEL                                                                                                                                                                                                                                                                                                               
G0292001003ADMINISTRATION(S) OF EXPERIMENTAL DRUG(S) ONLY IN A MEDICARE QUALIFYING         Adm exp drugs,clinical trial00      9                                                                                                     D                      0109O1E 1      0200301012005010120041231N                           
G0292002004CLINICAL TRIAL (INCLUDES ADMINISTRATION FOR CHEMOTHERAPY AND OTHER TYPES OF                                                                                                                                                                                                                                          
G0292003004THERAPY VIA INFUSION AND/OR OTHER THAN INFUSION), PER DAY                                                                                                                                                                                                                                                            
G0293001003NONCOVERED SURGICAL PROCEDURE(S) USING CONSCIOUS SEDATION, REGIONAL, GENERAL OR Non-cov surg proc,clin trial00      9                                                                                                     D                      0107Y2  2      02003010120030101        N                           
G0293002004SPINAL ANESTHESIA IN A MEDICARE QUALIFYING CLINICAL TRIAL, PER DAY                                                                                                                                                                                                                                                   
G0294001003NONCOVERED PROCEDURE(S) USING EITHER NO ANESTHESIA OR LOCAL ANESTHESIA ONLY, IN Non-cov proc, clinical trial00      9                                                                                                     D                      0109Y2  2      02003010120030101        N                           
G0294002004A MEDICARE QUALIFYING CLINICAL TRIAL, PER DAY                                                                                                                                                                                                                                                                        
G0295001003ELECTROMAGNETIC THERAPY, TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN        Electromagnetic therapy onc 00      935-98                                                                                                M                          I2B 1UW    02003040120040701        N                           
G0295002004DESCRIBED IN G0329 OR FOR OTHER USES                                                                                                                                                                                                                                                                                 
G0296001003PET IMAGING, FULL AND PARTIAL RING PET SCANNER ONLY, FOR RESTAGING OF           PET imge restag thyrod cance13      A                                                                                                     C                          I4B 4      0200310012005040120050331D                           
G0296002004PREVIOUSLY TREATED THYROID CANCER OF FOLLICULAR CELL ORIGIN FOLLOWING NEGATIVE                                                                                                                                                                                                                                       
G0296003004I-131 WHOLE BODY SCAN                                                                                                                                                                                                                                                                                                
G0297001003INSERTION OF SINGLE CHAMBER PACING CARDIOVERTER DEFIBRILLATOR PULSE GENERATOR   Insert single chamber/cd    00      9                                                                                                     C                          P2B 2      02003100120031001        N                           
G0298001003INSERTION OF DUAL CHAMBER PACING CARDIOVERTER DEFIBRILLATOR PULSE GENERATOR     Insert dual chamber/cd      00      9                                                                                                     C                          P2B 2      02003100120031001        N                           
G0299001003INSERTION OR REPOSITIONING OF ELECTRODE LEAD FOR SINGLE CHAMBER PACING          Inser/repos single icd+leads00      9                                                                                                     C                          P2B 2      02003100120031001        N                           
G0299002004CARDIOVERTER DEFIBRILLATOR AND INSERTION OF PULSE GENERATOR                                                                                                                                                                                                                                                          
G0300001003INSERTION OR REPOSITIONING OF ELECTRODE LEAD(S) FOR DUAL CHAMBER PACING         Insert reposit lead dual+gen00      9                                                                                                     C                          P2B 2      02003100120031001        N                           
G0300002004CARDIOVERTER DEFIBRILLATOR AND INSERTION OF PULSE GENERATOR                                                                                                                                                                                                                                                          
G0302001003PRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, COMPLETE     Pre-op service LVRS complete00      9                                                                                                     C                          T2D 1      02004010120040101        N                           
G0302002004COURSE OF SERVICES, TO INCLUDE A MINIMUM OF 16 DAYS OF SERVICES                                                                                                                                                                                                                                                      
G0303001003PRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, 10 TO 15     Pre-op service LVRS 10-15dos00      9                                                                                                     C                          T2D 1      02004010120040101        N                           
G0303002004DAYS OF SERVICES                                                                                                                                                                                                                                                                                                     
G0304001003PRE-OPERATIVE PULMONARY SURGERY SERVICES FOR PREPARATION FOR LVRS, 1 TO 9 DAYS  Pre-op service LVRS 1-9 dos 00      9                                                                                                     C                          T2D 1      02004010120040101        N                           
G0304002004OF SERVICES                                                                                                                                                                                                                                                                                                          
G0305001003POST-DISCHARGE PULMONARY SURGERY SERVICES AFTER LVRS, MINIMUM OF 6 DAYS OF      Post op service LVRS min 6  00      9                                                                                                     C                          T2D 1      02004010120040101        N                           
G0305002004SERVICES                                                                                                                                                                                                                                                                                                             
G0306001003COMPLETE CBC, AUTOMATED (HGB, HCT, RBC, WBC, WITHOUT PLATELET COUNT) AND        CBC/diffwbc w/o platelet    00      9                                                    400                                              C                          T1D 5      02004010120040101        N                           
G0306002004AUTOMATED WBC DIFFERENTIAL COUNT                                                                                                                                                                                                                                                                                     
G0307001003COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC; WITHOUT PLATELET COUNT)          CBC without platelet        00      9                                                    400                                              C                          T1D 5      02004010120040101        N                           
G0308001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svc 4+mo < 2yrs11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0308002004FOR PATIENTS UNDER 2 YEARS OF AGE TO INCLUDE MONITORING FOR THE ADEQUACY OF                                                                                                                                                                                                                                          
G0308003004NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF PARENTS;                                                                                                                                                                                                                                          
G0308004004WITH 4 OR MORE FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                               
G0309001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT  ESRD related svc 2-3mo <2yrs11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0309002004FOR PATIENTS UNDER 2 YEARS OF AGE TO INCLUDE MONITORING FOR THE ADEQUACY OF                                                                                                                                                                                                                                          
G0309003004NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF PARENTS;                                                                                                                                                                                                                                          
G0309004004WITH 2 OR 3 FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                                  
G0310001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svc 1 vst <2yrs11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0310002004FOR PATIENTS UNDER 2 YEARS OF AGE TO INCLUDE MONITORING FOR THE ADEQUACY OF                                                                                                                                                                                                                                          
G0310003004NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF PARENTS;                                                                                                                                                                                                                                          
G0310004004WITH 1 FACE-TO-FACE PHYSICIAN VISIT PER MONTH                                                                                                                                                                                                                                                                        
G0311001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 4+mo 2-11yr11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0311002004FOR PATIENTS BETWEEN 2 AND 11 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                             
G0311003004ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G0311004004PARENTS; WITH 4 OR MORE FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                      
G0312001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD relate svs 2-3 mo 2-11y11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0312002004FOR PATIENTS BETWEEN 2 AND 11 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                             
G0312003004ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G0312004004PARENTS; WITH 2 OR 3 FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                         
G0313001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 1 mon 2-11y11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0313002004FOR PATIENTS BETWEEN 2 AND 11 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                             
G0313003004ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G0313004004PARENTS; WITH 1 FACE-TO-FACE PHYSICIAN VISIT PER MONTH                                                                                                                                                                                                                                                               
G0314001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES, DURING THE COURSE OF           ESRD related svs 4+ mo 12-1911      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0314002004TREATMENT, FOR PATIENTS BETWEEN 12 AND 19 YEARS OF AGE TO INCLUDE MONITORING                                                                                                                                                                                                                                         
G0314003004FOR THE ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND                                                                                                                                                                                                                                             
G0314004004COUNSELING OF PARENTS; WITH 4 OR MORE FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                        
G0315001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 2-3mo/12-1911      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0315002004FOR PATIENTS BETWEEN 12 AND 19 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                            
G0315003004ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G0315004004PARENTS; WITH 2 OR 3 FACE-TO-FACE PHYSICIAN VISITS PER MONTH                                                                                                                                                                                                                                                         
G0316001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 1vis/12-19y11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0316002004FOR PATIENTS BETWEEN 12 AND 19 YEARS OF AGE TO INCLUDE MONITORING FOR THE                                                                                                                                                                                                                                            
G0316003004ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G0316004004PARENTS; WITH 1 FACE-TO-FACE PHYSICIAN VISIT PER MONTH                                                                                                                                                                                                                                                               
G0317001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 4+mo 20+yrs11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0317002004FOR PATIENTS 20 YEARS OF AGE AND OVER; WITH 4 OR MORE FACE-TO-FACE PHYSICIAN                                                                                                                                                                                                                                         
G0317003004VISITS PER MONTH                                                                                                                                                                                                                                                                                                     
G0318001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 2-3 mo 20+y11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0318002004FOR PATIENTS 20 YEARS OF AGE AND OVER; WITH 2 OR 3 FACE-TO-FACE PHYSICIAN                                                                                                                                                                                                                                            
G0318003004VISITS PER MONTH                                                                                                                                                                                                                                                                                                     
G0319001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES DURING THE COURSE OF TREATMENT, ESRD related svs 1visit 20+y11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0319002004FOR PATIENTS 20 YEARS OF AGE AND OVER; WITH 1 FACE-TO-FACE PHYSICIAN VISIT PER                                                                                                                                                                                                                                       
G0319003004MONTH                                                                                                                                                                                                                                                                                                                
G0320001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS PATIENTS PER  ESD related svs home undr 2 11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0320002004FULL MONTH; FOR PATIENTS UNDER TWO YEARS OF AGE TO INCLUDE MONITORING FOR                                                                                                                                                                                                                                            
G0320003004ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G0320004004PARENTS                                                                                                                                                                                                                                                                                                              
G0321001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS PATIENTS PER  ESRDrelatedsvs home mo 2-11y11      A                  2230                                                                               D                          P9B M      02004010120040701        N                           
G0321002004FULL MONTH; FOR PATIENTS TWO TO ELEVEN YEARS OF AGE TO INCLUDE MONITORING FOR                                                                                                                                                                                                                                        
G0321003004ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING OF                                                                                                                                                                                                                                       
G0321004004PARENTS                                                                                                                                                                                                                                                                                                              
G0322001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS PATIENTS PER  ESRD related svs hom mo12-1911      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0322002004FULL MONTH; FOR PATIENTS TWELVE TO NINETEEN YEARS OF AGE TO INCLUDE MONITORING                                                                                                                                                                                                                                       
G0322003004FOR ADEQUACY OF NUTRITION, ASSESSMENT OF GROWTH AND DEVELOPMENT, AND COUNSELING                                                                                                                                                                                                                                      
G0322004004OF PARENTS                                                                                                                                                                                                                                                                                                           
G0323001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS PATIENTS PER  ESRD related svs home mo 20+11      A                  2230                                                                               D                          P9B M      02004010120041001        N                           
G0323002004FULL MONTH; FOR PATIENTS TWENTY YEARS OF AGE AND OLDER                                                                                                                                                                                                                                                               
G0324001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS (LESS THAN    ESRD relate svs home/dy <2yr11      A                  2230                                                                               D                          P9B 1      02004010120040101        N                           
G0324002004FULL MONTH), PER DAY; FOR PATIENTS UNDER TWO YEARS OF AGE                                                                                                                                                                                                                                                            
G0325001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS (LESS THAN    ESRD relate home/day/ 2-11yr11      A                  2230                                                                               D                          P9B 1      02004010120040101        N                           
G0325002004FULL MONTH), PER DAY; FOR PATIENTS BETWEEN TWO AND ELEVEN YEARS OF AGE                                                                                                                                                                                                                                               
G0326001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS (LESS THAN    ESRD relate home/dy 12-19yr 11      A                  2230                                                                               D                          P9B 1      02004010120040101        N                           
G0326002004FULL MONTH), PER DAY; FOR PATIENTS BETWEEN TWELVE AND NINETEEN YEARS OF AGE                                                                                                                                                                                                                                          
G0327001003END STAGE RENAL DISEASE (ESRD) RELATED SERVICES FOR HOME DIALYSIS (LESS THAN    ESRD relate home/dy 20+yrs  11      A                  2230                                                                               D                          P9B 1      02004010120040101        N                           
G0327002004FULL MONTH), PER DAY; FOR PATIENTS TWENTY YEARS OF AGE AND OVER                                                                                                                                                                                                                                                      
G0328001003COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3          Fecal blood scrn immunoassay21      A                                                    310400                                           D                      0064T1H 1      02004010120040101        N                           
G0328002004SIMULTANEOUS                                                                                                                                                                                                                                                                                                         
G0329001003ELECTROMAGNETIC THERAPY, TO ONE OR MORE AREAS FOR CHRONIC STAGE III AND STAGE   Electromagntic tx for ulcers00      9                                                                                                     C                          I2B 1UW    02004070120040701        N                           
G0329002004IV PRESSURE ULCERS, ARTERIAL ULCERS, DIABETIC ULCERS AND VENOUS STASIS ULCERS                                                                                                                                                                                                                                        
G0329003004NOT DEMONSTRATING MEASURABLE SIGNS OF HEALING AFTER 30 DAYS OF CONVENTIONAL                                                                                                                                                                                                                                          
G0329004004CARE AS PART OF A THERAPY PLAN OF CARE                                                                                                                                                                                                                                                                               
G0336001003PET IMAGING, BRAIN IMAGING FOR THE DIFFERENTIAL DIAGNOSIS OF ALZHEIMER'S        PET imaging brain alzheimers13      A35-82                                                                                                D                          I4B 4      0200409152005040120050331D                           
G0336002004DISEASE WITH ABERRANT FEATURES VS FRONTO-TEMPORAL DEMENTIA                                                                                                                                                                                                                                                           
G0337001003HOSPICE EVALUATION AND COUNSELING SERVICES, PRE-ELECTION                        Hospice evaluation preelecti11      A                                                                                                     C                          M5D 1      02005010120050101        N                           
G0338001003LINEAR-ACCELERATOR-BASED STEREOTACTIC RADIOSURGERY PLAN, INCLUDING DOSE VOLUME  Linear accelerator stero pln00      9                                                                                                     C                          P5E 1      0200401012006010120051231D                           
G0338002004HISTOGRAMS FOR TARGET AND CRITICAL STRUCTURE TOLERANCES, PLAN OPTIMIZATION                                                                                                                                                                                                                                           
G0338003004PERFORMED FOR HIGHLY CONFORMAL DISTRIBUTIONS, PLAN POSITIONAL ACCURACY AND DOSE                                                                                                                                                                                                                                      
G0338004004VERIFICATION, ALL LESIONS TREATED, PER COURSE OF TREATMENT                                                                                                                                                                                                                                                           
G0339001003IMAGE-GUIDED ROBOTIC LINEAR ACCELERATOR-BASED STEREOTACTIC RADIOSURGERY,        Robot lin-radsurg com, first00      9                                                                                                     C                          P5E 1      02004010120040101        N                           
G0339002004COMPLETE COURSE OF THERAPY IN ONE SESSION OR FIRST SESSION OF FRACTIONATED                                                                                                                                                                                                                                           
G0339003004TREATMENT                                                                                                                                                                                                                                                                                                            
G0340001003IMAGE-GUIDED ROBOTIC LINEAR ACCELERATOR-BASED STEREOTACTIC RADIOSURGERY,        Robt lin-radsurg fractx 2-5 00      9                                                                                                     C                          P5E 1      02004010120040101        N                           
G0340002004DELIVERY INCLUDING COLLIMATOR CHANGES AND CUSTOM PLUGGING, FRACTIONATED                                                                                                                                                                                                                                              
G0340003004TREATMENT, ALL LESIONS, PER SESSION, SECOND THROUGH FIFTH SESSIONS, MAXIMUM                                                                                                                                                                                                                                          
G0340004004FIVE SESSIONS PER COURSE OF TREATMENT                                                                                                                                                                                                                                                                                
G0341001003PERCUTANEOUS ISLET CELL TRANSPLANT, INCLUDES PORTAL VEIN CATHETERIZATION AND    Percutaneous islet celltrans13      A260.3 35-82                                                                                          D                          P1G 2      02004100120041001        N                           
G0341002004INFUSION                                                                                                                                                                                                                                                                                                             
G0342001003LAPAROSCOPY FOR ISLET CELL TRANSPLANT, INCLUDES PORTAL VEIN CATHETERIZATION AND Laparoscopy islet cell trans13      A35-82                                                                                                D                          P1G 2      02004100120041001        N                           
G0342002004INFUSION                                                                                                                                                                                                                                                                                                             
G0343001003LAPAROTOMY FOR ISLET CELL TRANSPLANT, INCLUDES PORTAL VEIN CATHETERIZATION AND  Laparotomy islet cell transp13      A35-82                                                                                                D                          P1G 2      02004100120041001        N                           
G0343002004INFUSION                                                                                                                                                                                                                                                                                                             
G0344001003INITIAL PREVENTIVE PHYSICAL EXAMINATION; FACE-TO-FACE VISIT, SERVICES LIMITED   Initial preventive exam     11      A                                                                                                     C                          M1A 1      02005010120050101        N                           
G0344002004TO NEW BENEFICIARY DURING THE FIRST SIX MONTHS OF MEDICARE ENROLLMENT                                                                                                                                                                                                                                                
G0345001003INTRAVENOUS INFUSION, HYDRATION; INITIAL, UP TO ONE HOUR                        IV infuse hydration, initial11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0346001003EACH ADDITIONAL HOUR, UP TO EIGHT (8) HOURS (LIST SEPARATELY IN ADDITION TO     Each additional infuse hour 11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0346002004CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                          
G0347001003INTRAVENOUS INFUSION, FOR THERAPEUTIC/DIAGNOSTIC (SPECIFY SUBSTANCE OR DRUG);   IV infusion therapy/diagnost11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0347002004INITIAL, UP TO ONE HOUR                                                                                                                                                                                                                                                                                              
G0348001003EACH ADDITIONAL HOUR, UP TO EIGHT (8) HOURS (LIST SEPARATELY IN ADDITION TO     Each additional hr up to 8hr11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0348002004CODE FOR PRIMARY PROCEDURE AND REPORT IN CONJUNCTION WITH G0347)                                                                                                                                                                                                                                                     
G0349001003ADDITIONAL SEQUENTIAL INFUSION, UP TO ONE HOUR (LIST SEPARATELY IN ADDITION TO  Additional sequential infuse11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0349002004CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                          
G0350001003CONCURRENT INFUSION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Concurrent infusion         11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0350002004REPORT ONLY ONCE PER SUBSTANCE/DRUG REGARDLESS OF DURATION, REPORT G0350 IN                                                                                                                                                                                                                                          
G0350003004CONJUNCTION WITH G0345                                                                                                                                                                                                                                                                                               
G0351001003THERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS   Therapeutic/diagnostic injec11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0351002004OR INTRAMUSCULAR                                                                                                                                                                                                                                                                                                     
G0353001003INTRAVENOUS PUSH, SINGLE OR INITIAL SUBSTANCE/DRUG                              IV push,single orinitial dru11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0354001003EACH ADDITIONAL SEQUENTIAL INTRAVENOUS PUSH (LIST SEPARATELY IN ADDITION TO     Each addition sequential IV 11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0354002004CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                          
G0355001003CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR NON-HORMONAL         Chemo adminisrate subcut/IM 11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0355002004ANTINEOPLASTIC                                                                                                                                                                                                                                                                                                       
G0356001003HORMONAL ANTI-NEOPLASTIC                                                        Hormonal anti-neoplastic    11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0357001003INTRAVENOUS, PUSH TECHNIQUE, SINGLE OR INITIAL SUBSTANCE/DRUG                   IV push single/initial subst11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0358001003INTRAVENOUS, PUSH TECHNIQUE, EACH ADDITIONAL SUBSTANCE/DRUG (LIST SEPARATELY IN IV push each additional drug11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0358002004ADDITION TO CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                              
G0359001003CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; UP TO ONE HOUR,    Chemotherapy IV one hr initi11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0359002004SINGLE OR INITIAL SUBSTANCE/DRUG                                                                                                                                                                                                                                                                                     
G0360001003EACH ADDITIONAL HOUR, ONE TO EIGHT (8) HOURS (LIST SEPARATELY IN ADDITION TO    Each additional hr 1-8 hrs  11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0360002004CODE FOR PRIMARY PROCEDURE) USE G0360 IN CONJUNCTION WITH G0359                                                                                                                                                                                                                                                      
G0361001003INITIATION OF PROLONGED CHEMOTHERAPY INFUSION (MORE THAN EIGHT HOURS),          Prolong chemo infuse>8hrs pu11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0361002004REQUIRING USE OF A PORTABLE OR IMPLANTABLE PUMP                                                                                                                                                                                                                                                                      
G0362001003EACH ADDITIONAL SEQUENTIAL INFUSION (DIFFERENT SUBSTANCE/DRUG), UP TO ONE HOUR  Each add sequential infusion11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0362002004(USE WITH G0359)                                                                                                                                                                                                                                                                                                     
G0363001003IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS (DO NOT  Irrigate implanted venous de11      A                                                                                                     C                          P6C 1      0200501012006010120051231D                           
G0363002004REPORT G0363 IF AN INJECTION OR INFUSION IS PROVIDED ON THE SAME DAY)                                                                                                                                                                                                                                                
G0364001003BONE MARROW ASPIRATION PERFORMED WITH BONE MARROW BIOPSY THROUGH THE SAME       Bone marrow aspirate &biopsy11      A                                                                                                     C                          P6C 2      02005010120050101        N                           
G0364002004INCISION ON THE SAME DATE OF SERVICE                                                                                                                                                                                                                                                                                 
G0365001003VESSEL MAPPING OF VESSELS FOR HEMODIALYSIS ACCESS (SERVICES FOR PREOPERATIVE    Vessel mapping hemo access  11      A                                                                                                     C                          P9A 5      02005010120050101        N                           
G0365002004VESSEL MAPPING PRIOR TO CREATION OF HEMODIALYSIS ACCESS USING AN AUTOGENOUS                                                                                                                                                                                                                                          
G0365003004HEMODIALYSIS CONDUIT, INCLUDING ARTERIAL INFLOW AND VENOUS OUTFLOW)                                                                                                                                                                                                                                                  
G0366001003ELECTROCARDIOGRAM, ROUTINE ECG WITH 12 LEADS; PERFORMED AS A COMPONENT OF THE   EKG for initial prevent exam11      A                                                                                                     C                          T2C 5      02005010120050101        N                           
G0366002004INITIAL PREVENTIVE EXAMINATION WITH INTERPRETATION AND REPORT                                                                                                                                                                                                                                                        
G0367001003TRACING ONLY, WITHOUT INTERPRETATION AND REPORT, PERFORMED AS A COMPONENT OF    EKG tracing for initial prev11      A                                                                                                     C                          T2C 5      02005010120050101        N                           
G0367002004THE INITIAL PREVENTIVE EXAMINATION                                                                                                                                                                                                                                                                                   
G0368001003INTERPRETATION AND REPORT ONLY, PERFORMED AS A COMPONENT OF THE INITIAL         EKG interpret & report preve11      A                                                                                                     C                          T2C 5      02005010120050101        N                           
G0368002004PREVENTIVE EXAMINATION                                                                                                                                                                                                                                                                                               
G0369001003PHARMACY SUPPLY FEE FOR INITIAL IMMUNOSUPPRESSIVE DRUG(S) FIRST MONTH FOLLOWING Pharm fee 1st month transpla46      A                                                                            Q0510                    D                      0121D1E 9      0200501012006010120051231D                           
G0369002004TRANSPLANT                                                                                                                                                                                                                                                                                                           
G0370001003PHARMACY SUPPLY FEE FOR ORAL ANTI-CANCER, ORAL ANTI-EMETIC OR IMMUNOSUPPRESSIVE Pharmacy fee oral cancer etc46      A                                                                            Q0511Q0512               D                      0121D1E 9      0200501012006010120051231D                           
G0370002004DRUG(S)                                                                                                                                                                                                                                                                                                              
G0371001003PHARMACY DISPENSING FEE FOR INHALATION DRUG(S); PER 30 DAYS                     Pharm dispense inhalation 3046      A                                                                            Q0513                    D                      0121D1E 9      0200501012006010120051231D                           
G0372001003PHYSICIAN SERVICE REQUIRED TO ESTABLISH AND DOCUMENT THE NEED FOR A POWER       MD service required for PMD 13      A                                                                                                     D                      0128M5D 1      02005102520051025        A                           
G0372002004MOBILITY DEVICE (USE IN ADDITION TO PRIMARY EVALUATION AND MANAGEMENT CODE)                                                                                                                                                                                                                                          
G0374001003PHARMACY DISPENSING FEE FOR INHALATION DRUG(S); PER 90 DAYS                     Pharm dispense inhalation 9046      A                                                                            Q0514                    D                      0121D1E 9      0200501012006010120051231D                           
G0375001003SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN  Smoke/tobacco counselng 3-1013      A                                                                                                     C                          M6  1      02005032320050323        A                           
G03750020043 MINUTES UP TO 10 MINUTES                                                                                                                                                                                                                                                                                           
G0376001003SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTENSIVE, GREATER THAN 10  Smoke/tobacco counseling >1013      A                                                                                                     C                          M6  1      02005032320050323        A                           
G0376002004MINUTES                                                                                                                                                                                                                                                                                                              
G0378001003HOSPITAL OBSERVATION SERVICE, PER HOUR                                          Hospital observation per hr 00      9                                                                                                     D                      0107M2A 1      02006010120060101        A                           
G0379001003DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE                       Direct admit hospital observ00      9                                                                                                     D                      0107M2A 1      02006010120060101        A                           
G3001001003ADMINISTRATION AND SUPPLY OF TOSITUMOMAB, 450 MG                                Admin + supply, tositumomab 13      A                                                                                                     C                          T2D 1      02003070120030701        N                           
G9001001003COORDINATED CARE FEE, INITIAL RATE                                              MCCD, initial rate          00      9                                                                                                     D                      0097Y2  1      02000100120001001        N                           
G9002001003COORDINATED CARE FEE, MAINTENANCE RATE                                          MCCD,maintenance rate       00      9                                                                                                     D                      0097Y2  1      02000100120001001        N                           
G9003001003COORDINATED CARE FEE, RISK ADJUSTED HIGH, INITIAL                               MCCD, risk adj hi, initial  00      9                                                                                                     D                      0097Y2  1      02000100120001001        N                           
G9004001003COORDINATED CARE FEE, RISK ADJUSTED LOW, INITIAL                                MCCD, risk adj lo, initial  00      9                                                                                                     D                      0097Y2  1      02000100120001001        N                           
G9005001003COORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE                                 MCCD, risk adj, maintenance 00      9                                                                                                     D                      0097Y2  1      02000100120001001        N                           
G9006001003COORDINATED CARE FEE, HOME MONITORING                                           MCCD, Home monitoring       00      9                                                                                                     D                      0097Y2  1      02000100120001001        N                           
G9007001003COORDINATED CARE FEE, SCHEDULED TEAM CONFERENCE                                 MCCD, sch team conf         00      9                                                                                                     D                      0097Y2  1      02000100120001001        N                           
G9008001003COORDINATED CARE FEE, PHYSICIAN COORDINATED CARE OVERSIGHT SERVICES             Mccd,phys coor-care ovrsght 00      9                                                                                                     D                      0097Y2  1      02000100120001001        N                           
G9009001003COORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE, LEVEL 3                        MCCD, risk adj, level 3     00      9                                                                                                     D                      0096Y2  1      02001100120011001        N                           
G9010001003COORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE, LEVEL 4                        MCCD, risk adj, level 4     00      9                                                                                                     D                      0096Y2  1      02001100120011001        N                           
G9011001003COORDINATED CARE FEE, RISK ADJUSTED MAINTENANCE, LEVEL 5                        MCCD, risk adj, level 5     00      9                                                                                                     D                      0096Y2  1      02001100120011001        N                           
G9012001003OTHER SPECIFIED CASE MANAGEMENT SERVICE NOT ELSEWHERE CLASSIFIED                Other Specified Case Mgmt   00      9                                                                                                     D                      0096Y2  1      02001100120011001        N                           
G9013001003ESRD DEMO BASIC BUNDLE LEVEL I                                                  ESRD demo bundle level I    00      9                                                                                                     M                      0096Y2  1      02004070120040701        N                           
G9014001003ESRD DEMO EXPANDED BUNDLE INCLUDING VENOUS ACCESS AND RELATED SERVICES          ESRD demo bundle-level II   00      9                                                                                                     M                      0096Y2  1      02004070120040701        N                           
G9016001003SMOKING CESSATION COUNSELING, INDIVIDUAL, IN THE ABSENCE OF OR IN ADDITION TO   Demo-smoking cessation coun 00      9                                                                                                     M                      0096Y2  1      02001010120010101        N                           
G9016002004ANY OTHER EVALUATION AND MANAGEMENT SERVICE, PER SESSION (6-10 MINUTES) [DEMO                                                                                                                                                                                                                                        
G9016003004PROJECT CODE ONLY]                                                                                                                                                                                                                                                                                                   
G9017001003AMANTADINE HYDROCHLORIDE, ORAL, PER 100 MG (FOR USE IN A MEDICARE-APPROVED      Amantadine HCL 100mg oral   13      A                                                                                                     C                          O1E 1      02004120120041201        N                           
G9017002004DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G9018001003ZANAMIVIR, INHALATION POWDER, ADMINISTERED THROUGH INHALER, PER 10 MG (FOR USE  Zanamivir,inhalation pwd 10m13      A                                                                                                     C                          O1E 1      02004120120041201        N                           
G9018002004IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                        
G9019001003OSELTAMIVIR PHOSPHATE, ORAL, PER 75 MG (FOR USE IN A MEDICARE-APPROVED          Oseltamivir phosphate 75mg  13      A                                                                                                     C                          O1E 1      02004120120041201        N                           
G9019002004DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G9020001003RIMANTADINE HYDROCHLORIDE, ORAL, PER 100 MG (FOR USE IN A MEDICARE-APPROVED     Rimantadine HCL 100mg oral  13      A                                                                                                     C                          O1E 1      02004120120041201        N                           
G9020002004DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G9021001003CHEMOTHERAPY ASSESSMENT FOR NAUSEA AND/OR VOMITING, PATIENT REPORTED, PERFORMED Chemo assess nausea vomit L113      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9021002004AT THE TIME OF CHEMOTHERAPY ADMINISTRATION; ASSESSMENT LEVEL ONE: NOT AT ALL                                                                                                                                                                                                                                         
G9021003004(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G9022001003CHEMOTHERAPY ASSESSMENT FOR NAUSEA AND/OR VOMITING, PATIENT REPORTED, PERFORMED Chemo assess nausea vomit L213      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9022002004AT THE TIME OF CHEMOTHERAPY ADMINISTRATION; ASSESSMENT LEVEL TWO: A LITTLE (FOR                                                                                                                                                                                                                                      
G9022003004USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                    
G9023001003CHEMOTHERAPY ASSESSMENT FOR NAUSEA AND/OR VOMITING, PATIENT REPORTED, PERFORMED Chemo assess nausea vomit L313      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9023002004AT THE TIME OF CHEMOTHERAPY ADMINISTRATION; ASSESSMENT LEVEL THREE: QUITE A BIT                                                                                                                                                                                                                                      
G9023003004(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G9024001003CHEMOTHERAPY ASSESSMENT FOR NAUSEA AND/OR VOMITING, PATIENT REPORTED, PERFORMED Chemo assess nausea vomit L413      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9024002004AT THE TIME OF CHEMOTHERAPY ADMINISTRATION; ASSESSMENT LEVEL FOUR: VERY MUCH                                                                                                                                                                                                                                         
G9024003004(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G9025001003CHEMOTHERAPY ASSESSMENT FOR PAIN, PATIENT REPORTED, PERFORMED AT THE TIME OF    Chemo assessment pain level113      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9025002004CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL ONE: NOT AT ALL (FOR USE IN A                                                                                                                                                                                                                                          
G9025003004MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G9026001003CHEMOTHERAPY ASSESSMENT FOR PAIN, PATIENT REPORTED, PERFORMED AT THE TIME OF    Chemo assessment pain level213      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9026002004CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL TWO: A LITTLE (FOR USE IN A                                                                                                                                                                                                                                            
G9026003004MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G9027001003CHEMOTHERAPY ASSESSMENT FOR PAIN, PATIENT REPORTED, PERFORMED AT THE TIME OF    Chemo assessment pain level313      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9027002004CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL THREE: QUITE A BIT (FOR USE IN A                                                                                                                                                                                                                                       
G9027003004MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G9028001003CHEMOTHERAPY ASSESSMENT FOR PAIN, PATIENT REPORTED, PERFORMED AT THE TIME OF    Chemo assessment pain level413      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9028002004CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL FOUR: VERY MUCH (FOR USE IN A                                                                                                                                                                                                                                          
G9028003004MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G9029001003CHEMOTHERAPY ASSESSMENT FOR LACK OF ENERGY (FATIGUE), PATIENT REPORTED,         Chemo assess for fatigue L1 13      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9029002004PERFORMED AT THE TIME OF CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL ONE: NOT                                                                                                                                                                                                                                      
G9029003004AT ALL (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                        
G9030001003CHEMOTHERAPY ASSESSMENT FOR LACK OF ENERGY (FATIGUE), PATIENT REPORTED,         Chemo assess for fatigue L2 13      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9030002004PERFORMED AT THE TIME OF CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL TWO: A                                                                                                                                                                                                                                        
G9030003004LITTLE (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                        
G9031001003CHEMOTHERAPY ASSESSMENT FOR LACK OF ENERGY (FATIGUE), PATIENT REPORTED,         Chemo assess for fatigue L3 13      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9031002004PERFORMED AT THE TIME OF CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL THREE:                                                                                                                                                                                                                                        
G9031003004QUITE A BIT (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                   
G9032001003CHEMOTHERAPY ASSESSMENT FOR LACK OF ENERGY (FATIGUE), PATIENT REPORTED,         Chemo assess for fatigue L4 13      A                                                                                                     C                          P7B 1      02005010120050101        N                           
G9032002004PERFORMED AT THE TIME OF CHEMOTHERAPY ADMINISTRATION, ASSESSMENT LEVEL FOUR:                                                                                                                                                                                                                                         
G9032003004VERY MUCH (FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                     
G9033001003AMANTADINE HYDROCHLORIDE, ORAL BRAND, PER 100 MG (FOR USE IN A                  Amantadine HCL oral brand   13      A                                                                                                     C                          O1E 1      02004120120041201        A                           
G9033002004MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G9034001003ZANAMIVIR, INHALATION POWDER, ADMINISTERED THROUGH INHALER, BRAND, PER 10 MG    Zanamivir, inh pwdr, brand  00      9                                                                                                     C                          O1E 1      02004120120041201        N                           
G9034002004(FOR USE IN A MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                               
G9035001003OSELTAMIVIR PHOSPHATE, ORAL, BRAND, PER 75 MG (FOR USE IN A MEDICARE-APPROVED   Oseltamivir phosp, brand    00      9                                                                                                     C                          O1E 1      02004120120041201        N                           
G9035002004DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                                               
G9036001003RIMANTADINE HYDROCHLORIDE, ORAL, BRAND, PER 100 MG (FOR USE IN A                Rimantadine HCL, brand      00      9                                                                                                     C                          O1E 1      02004120120041201        N                           
G9036002004MEDICARE-APPROVED DEMONSTRATION PROJECT)                                                                                                                                                                                                                                                                             
G9041001003SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE        Low vision rehab occupationa00      9                                                                                                     C                          T2D 1      02006010120060101        A                           
G9041002004ADAPTIVE RESPONSES TO ENVIRONMENTAL DEMANDS, SELF CARE/HOME MANAGEMENT TRAINING                                                                                                                                                                                                                                      
G9041003004(E.G. ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING, MEAL                                                                                                                                                                                                                                               
G9041004004PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ASSISTIVE TECHNOLOGY                                                                                                                                                                                                                                      
G9041005004DEVICES/ADAPTIVE EQUIPMENT), COMMUNITY/WORK REINTEGRATION TRAINING (E.G.                                                                                                                                                                                                                                             
G9041006004SHOPPING, TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/OR WORK                                                                                                                                                                                                                                       
G9041007004ENVIRONMENT MODIFICATION ANALYSIS, WORK TASK ANALYSIS), DIRECT ONE-ON-ONE                                                                                                                                                                                                                                            
G9041008004CONTACT BY THE PROVIDER, EACH 15 MINUTES                                                                                                                                                                                                                                                                             
G9042001003SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE        Low vision rehab orient/mobi00      9                                                                                                     C                          T2D 1      02006010120060101        A                           
G9042002004ADAPTIVE RESPONSES TO ENVIRONMENTAL DEMANDS, SELF CARE/HOME MANAGEMENT TRAINING                                                                                                                                                                                                                                      
G9042003004(E.G. ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING, MEAL                                                                                                                                                                                                                                               
G9042004004PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ASSISTIVE TECHNOLOGY                                                                                                                                                                                                                                      
G9042005004DEVICES/ADAPTIVE EQUIPMENT), COMMUNITY/WORK REINTEGRATION TRAINING (E.G.                                                                                                                                                                                                                                             
G9042006004SHOPPING, TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/OR WORK                                                                                                                                                                                                                                       
G9042007004ENVIRONMMENT MODIFICATION ANALYSIS, WORK TASK ANALYSIS), DIRECT ONE-ON-ONE                                                                                                                                                                                                                                           
G9042008004CONTACT BY THE PROVIDER, EACH 15 MINUTES                                                                                                                                                                                                                                                                             
G9043001003SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE        Low vision lowvision therapi00      9                                                                                                     C                          T2D 1      02006010120060101        A                           
G9043002004ADAPTIVE RESPONSES TO ENVIRONMENTAL DEMANDS, SELF CARE/HOME MANAGEMENT TRAINING                                                                                                                                                                                                                                      
G9043003004(E.G. ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING, MEAL                                                                                                                                                                                                                                               
G9043004004PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ASSISTIVE TECHNOLOGY                                                                                                                                                                                                                                      
G9043005004DEVICES/ADAPTIVE EQUIPMENT), COMMUNITY/WORK REINTEGRATION TRAINING (E.G.                                                                                                                                                                                                                                             
G9043006004SHOPPING, TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/OR WORK                                                                                                                                                                                                                                       
G9043007004ENVIRONMENT MODIFICATION ANALYSIS, WORK TASK ANAYLSIS), DIRECT ONE-ON-ONE                                                                                                                                                                                                                                            
G9043008004CONTACT BY THE PROVIDER, EACH 15 MINUTES                                                                                                                                                                                                                                                                             
G9044001003SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE        Low vision rehabilate teache00      9                                                                                                     C                          T2D 1      02006010120060101        A                           
G9044002004ADAPTIVE RESPONSES TO ENVIRONMENTAL DEMANDS, SELF CARE/HOME MANAGEMENT TRAINING                                                                                                                                                                                                                                      
G9044003004(E.G. ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING, MEAL                                                                                                                                                                                                                                               
G9044004004PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ASSISTIVE TECHNOLOGY                                                                                                                                                                                                                                      
G9044005004DEVICES/ADAPTIVE EQUIPMENT), COMMUNITY/WORK REINTEGRATION TRAINING (E.G.                                                                                                                                                                                                                                             
G9044006004SHOPPING, TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/OR WORK                                                                                                                                                                                                                                       
G9044007004ENVIRONMENT MODIFICATION ANALYSIS, WORK TASK ANALYSIS), DIRECT ONE-ON-ONE                                                                                                                                                                                                                                            
G9044008004CONTACT BY THE PROVIDER, EACH 15 MINUTES                                                                                                                                                                                                                                                                             
H0001001003ALCOHOL AND/OR DRUG ASSESSMENT                                                  Alcohol and/or drug assess  00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0002001003BEHAVIORAL HEALTH SCREENING TO DETERMINE ELIGIBILITY FOR ADMISSION TO TREATMENT Alcohol and/or drug screenin00      9                                                                                                     I                          Z2  9      02001010120030101        N                           
H0002002004PROGRAM                                                                                                                                                                                                                                                                                                              
H0003001003ALCOHOL AND/OR DRUG SCREENING; LABORATORY ANALYSIS OF SPECIMENS FOR PRESENCE OF Alcohol and/or drug screenin00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0003002004ALCOHOL AND/OR DRUGS                                                                                                                                                                                                                                                                                                 
H0004001003BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES                        Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120030101        N                           
H0005001003ALCOHOL AND/OR DRUG SERVICES; GROUP COUNSELING BY A CLINICIAN                   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0006001003ALCOHOL AND/OR DRUG SERVICES; CASE MANAGEMENT                                   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0007001003ALCOHOL AND/OR DRUG SERVICES; CRISIS INTERVENTION (OUTPATIENT)                  Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0008001003ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (HOSPITAL INPATIENT)     Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0009001003ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (HOSPITAL INPATIENT)         Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0010001003ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0010002004PROGRAM INPATIENT)                                                                                                                                                                                                                                                                                                   
H0011001003ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION       Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0011002004PROGRAM INPATIENT)                                                                                                                                                                                                                                                                                                   
H0012001003ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0012002004PROGRAM OUTPATIENT)                                                                                                                                                                                                                                                                                                  
H0013001003ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION       Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0013002004PROGRAM OUTPATIENT)                                                                                                                                                                                                                                                                                                  
H0014001003ALCOHOL AND/OR DRUG SERVICES; AMBULATORY DETOXIFICATION                         Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0015001003ALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENT (TREATMENT PROGRAM THAT      Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0015002004OPERATES AT LEAST 3 HOURS/DAY AND AT LEAST 3 DAYS/WEEK AND IS BASED ON AN                                                                                                                                                                                                                                            
H0015003004INDIVIDUALIZED TREATMENT PLAN), INCLUDING ASSESSMENT, COUNSELING; CRISIS                                                                                                                                                                                                                                             
H0015004004INTERVENTION, AND ACTIVITY THERAPIES OR EDUCATION                                                                                                                                                                                                                                                                    
H0016001003ALCOHOL AND/OR DRUG SERVICES; MEDICAL/SOMATIC (MEDICAL INTERVENTION IN          Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0016002004AMBULATORY SETTING)                                                                                                                                                                                                                                                                                                  
H0017001003BEHAVIORAL HEALTH; RESIDENTIAL (HOSPITAL RESIDENTIAL TREATMENT PROGRAM),        Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120030101        N                           
H0017002004WITHOUT ROOM AND BOARD, PER DIEM                                                                                                                                                                                                                                                                                     
H0018001003BEHAVIORAL HEALTH; SHORT-TERM RESIDENTIAL (NON-HOSPITAL RESIDENTIAL TREATMENT   Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120030101        N                           
H0018002004PROGRAM), WITHOUT ROOM AND BOARD, PER DIEM                                                                                                                                                                                                                                                                           
H0019001003BEHAVIORAL HEALTH; LONG-TERM RESIDENTIAL (NON-MEDICAL, NON-ACUTE CARE IN A      Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120030101        N                           
H0019002004RESIDENTIAL TREATMENT PROGRAM WHERE STAY IS TYPICALLY LONGER THAN 30 DAYS),                                                                                                                                                                                                                                          
H0019003004WITHOUT ROOM AND BOARD, PER DIEM                                                                                                                                                                                                                                                                                     
H0020001003ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE           Alcohol and/or drug services00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0020002004(PROVISION OF THE DRUG BY A LICENSED PROGRAM)                                                                                                                                                                                                                                                                        
H0021001003ALCOHOL AND/OR DRUG TRAINING SERVICE (FOR STAFF AND PERSONNEL NOT EMPLOYED BY   Alcohol and/or drug training00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0021002004PROVIDERS)                                                                                                                                                                                                                                                                                                           
H0022001003ALCOHOL AND/OR DRUG INTERVENTION SERVICE (PLANNED FACILITATION)                 Alcohol and/or drug interven00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0023001003BEHAVIORAL HEALTH OUTREACH SERVICE (PLANNED APPROACH TO REACH A TARGETED        Alcohol and/or drug outreach00      9                                                                                                     I                          Z2  9      02001010120030101        N                           
H0023002004POPULATION)                                                                                                                                                                                                                                                                                                          
H0024001003BEHAVIORAL HEALTH PREVENTION INFORMATION DISSEMINATION SERVICE (ONE-WAY DIRECT  Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120030101        N                           
H0024002004OR NON-DIRECT CONTACT WITH SERVICE AUDIENCES TO AFFECT KNOWLEDGE AND ATTITUDE)                                                                                                                                                                                                                                       
H0025001003BEHAVIORAL HEALTH PREVENTION EDUCATION SERVICE (DELIVERY OF SERVICES WITH       Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120030101        N                           
H0025002004TARGET POPULATION TO AFFECT KNOWLEDGE, ATTITUDE AND/OR BEHAVIOR)                                                                                                                                                                                                                                                     
H0026001003ALCOHOL AND/OR DRUG PREVENTION PROCESS SERVICE, COMMUNITY-BASED (DELIVERY OF    Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0026002004SERVICES TO DEVELOP SKILLS OF IMPACTORS)                                                                                                                                                                                                                                                                             
H0027001003ALCOHOL AND/OR DRUG PREVENTION ENVIRONMENTAL SERVICE (BROAD RANGE OF EXTERNAL   Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0027002004ACTIVITIES GEARED TOWARD MODIFYING SYSTEMS IN ORDER TO MAINSTREAM PREVENTION                                                                                                                                                                                                                                         
H0027003004THROUGH POLICY AND LAW)                                                                                                                                                                                                                                                                                              
H0028001003ALCOHOL AND/OR DRUG PREVENTION PROBLEM IDENTIFICATION AND REFERRAL SERVICE      Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0028002004(E.G. STUDENT ASSISTANCE AND EMPLOYEE ASSISTANCE PROGRAMS), DOES NOT INCLUDE                                                                                                                                                                                                                                         
H0028003004ASSESSMENT                                                                                                                                                                                                                                                                                                           
H0029001003ALCOHOL AND/OR DRUG PREVENTION ALTERNATIVES SERVICE (SERVICES FOR POPULATIONS   Alcohol and/or drug preventi00      9                                                                                                     I                          Z2  9      02001010120010101        N                           
H0029002004THAT EXCLUDE ALCOHOL AND OTHER DRUG USE E.G. ALCOHOL FREE SOCIAL EVENTS)                                                                                                                                                                                                                                             
H0030001003BEHAVIORAL HEALTH HOTLINE SERVICE                                               Alcohol and/or drug hotline 00      9                                                                                                     I                          Z2  9      02001010120030101        N                           
H0031001003MENTAL HEALTH ASSESSMENT, BY NON-PHYSICIAN                                      MH health assess by non-md  00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0032001003MENTAL HEALTH SERVICE PLAN DEVELOPMENT BY NON-PHYSICIAN                         MH svc plan dev by non-md   00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0033001003ORAL MEDICATION ADMINISTRATION, DIRECT OBSERVATION                              Oral med adm direct observe 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0034001003MEDICATION TRAINING AND SUPPORT, PER 15 MINUTES                                 Med trng & support per 15min00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0035001003MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS            MH partial hosp tx under 24h00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0036001003COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT, FACE-TO-FACE, PER 15 MINUTES        Comm psy face-face per 15min00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0037001003COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT PROGRAM, PER DIEM                    Comm psy sup tx pgm per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0038001003SELF-HELP/PEER SERVICES, PER 15 MINUTES                                         Self-help/peer svc per 15min00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0039001003ASSERTIVE COMMUNITY TREATMENT, FACE-TO-FACE, PER 15 MINUTES                     Asser com tx face-face/15min00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0040001003ASSERTIVE COMMUNITY TREATMENT PROGRAM, PER DIEM                                 Assert comm tx pgm per diem 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0041001003FOSTER CARE, CHILD, NON-THERAPEUTIC, PER DIEM                                   Fos c chld non-ther per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0042001003FOSTER CARE, CHILD, NON-THERAPEUTIC, PER MONTH                                  Fos c chld non-ther per mon 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0043001003SUPPORTED HOUSING, PER DIEM                                                     Supported housing, per diem 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0044001003SUPPORTED HOUSING, PER MONTH                                                    Supported housing, per month00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0045001003RESPITE CARE SERVICES, NOT IN THE HOME, PER DIEM                                Respite not-in-home per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0046001003MENTAL HEALTH SERVICES, NOT OTHERWISE SPECIFIED                                 Mental health service, nos  00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0047001003ALCOHOL AND/OR OTHER DRUG ABUSE SERVICES, NOT OTHERWISE SPECIFIED               Alcohol/drug abuse svc nos  00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0048001003ALCOHOL AND/OR OTHER DRUG TESTING: COLLECTION AND HANDLING ONLY, SPECIMENS      Spec coll non-blood:a/d test00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H0048002004OTHER THAN BLOOD                                                                                                                                                                                                                                                                                                     
H1000001003PRENATAL CARE, AT-RISK ASSESSMENT                                               Prenatal care atrisk assessm00      9                                                                                                     I                          Z2  9      02002010120020101        N                           
H1001001003PRENATAL CARE, AT-RISK ENHANCED SERVICE; ANTEPARTUM MANAGEMENT                  Antepartum management       00      9                                                                                                     I                          Z2  9      02002010120020101        N                           
H1002001003PRENATAL CARE, AT RISK ENHANCED SERVICE; CARE COORDINATION                      Carecoordination prenatal   00      9                                                                                                     I                          Z2  9      02002010120020101        N                           
H1003001003PRENATAL CARE, AT-RISK ENHANCED SERVICE; EDUCATION                              Prenatal at risk education  00      9                                                                                                     I                          Z2  9      02002010120020101        N                           
H1004001003PRENATAL CARE, AT-RISK ENHANCED SERVICE; FOLLOW-UP HOME VISIT                   Follow up home visit/prental00      9                                                                                                     I                          Z2  9      02002010120020101        N                           
H1005001003PRENATAL CARE, AT-RISK ENHANCED SERVICE PACKAGE (INCLUDES H1001-H1004)          Prenatalcare enhanced srv pk00      9                                                                                                     I                          Z2  9      02002010120020101        N                           
H1010001003NON-MEDICAL FAMILY PLANNING EDUCATION, PER SESSION                              Nonmed family planning ed   00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H1011001003FAMILY ASSESSMENT BY LICENSED BEHAVIORAL HEALTH PROFESSIONAL FOR STATE DEFINED  Family assessment           00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H1011002004PURPOSES                                                                                                                                                                                                                                                                                                             
H2000001003COMPREHENSIVE MULTIDISCIPLINARY EVALUATION                                      Comp multidisipln evaluation00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H2001001003REHABILITATION PROGRAM, PER 1/2 DAY                                             Rehabilitation program 1/2 d00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
H2010001003COMPREHENSIVE MEDICATION SERVICES, PER 15 MINUTES                               Comprehensive med svc 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2011001003CRISIS INTERVENTION SERVICE, PER 15 MINUTES                                     Crisis interven svc, 15 min 00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2012001003BEHAVIORAL HEALTH DAY TREATMENT, PER HOUR                                       Behav hlth day treat, per hr00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2013001003PSYCHIATRIC HEALTH FACILITY SERVICE, PER DIEM                                   Psych hlth fac svc, per diem00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2014001003SKILLS TRAINING AND DEVELOPMENT, PER 15 MINUTES                                 Skills train and dev, 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2015001003COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES                        Comp comm supp svc, 15 min  00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2016001003COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER DIEM                              Comp comm supp svc, per diem00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2017001003PSYCHOSOCIAL REHABILITATION SERVICES, PER 15 MINUTES                            Psysoc rehab svc, per 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2018001003PSYCHOSOCIAL REHABILITATION SERVICES, PER DIEM                                  Psysoc rehab svc, per diem  00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2019001003THERAPEUTIC BEHAVIORAL SERVICES, PER 15 MINUTES                                 Ther behav svc, per 15 min  00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2020001003THERAPEUTIC BEHAVIORAL SERVICES, PER DIEM                                       Ther behav svc, per diem    00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2021001003COMMUNITY-BASED WRAP-AROUND SERVICES, PER 15 MINUTES                            Com wrap-around sv, 15 min  00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2022001003COMMUNITY-BASED WRAP-AROUND SERVICES, PER DIEM                                  Com wrap-around sv, per diem00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2023001003SUPPORTED EMPLOYMENT, PER 15 MINUTES                                            Supported employ, per 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2024001003SUPPORTED EMPLOYMENT, PER DIEM                                                  Supported employ, per diem  00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2025001003ONGOING SUPPORT TO MAINTAIN EMPLOYMENT, PER 15 MINUTES                          Supp maint employ, 15 min   00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2026001003ONGOING SUPPORT TO MAINTAIN EMPLOYMENT, PER DIEM                                Supp maint employ, per diem 00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2027001003PSYCHOEDUCATIONAL SERVICE, PER 15 MINUTES                                       Psychoed svc, per 15 min    00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2028001003SEXUAL OFFENDER TREATMENT SERVICE, PER 15 MINUTES                               Sex offend tx svc, 15 min   00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2029001003SEXUAL OFFENDER TREATMENT SERVICE, PER DIEM                                     Sex offend tx svc, per diem 00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2030001003MENTAL HEALTH CLUBHOUSE SERVICES, PER 15 MINUTES                                MH clubhouse svc, per 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2031001003MENTAL HEALTH CLUBHOUSE SERVICES, PER DIEM                                      MH clubhouse svc, per diem  00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2032001003ACTIVITY THERAPY, PER 15 MINUTES                                                Activity therapy, per 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2033001003MULTISYSTEMIC THERAPY FOR JUVENILES, PER 15 MINUTES                             Multisys ther/juvenile 15min00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2034001003ALCOHOL AND/OR DRUG ABUSE HALFWAY HOUSE SERVICES, PER DIEM                      A/D halfway house, per diem 00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2035001003ALCOHOL AND/OR OTHER DRUG TREATMENT PROGRAM, PER HOUR                           A/D tx program, per hour    00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2036001003ALCOHOL AND/OR OTHER DRUG TREATMENT PROGRAM, PER DIEM                           A/D tx program, per diem    00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2037001003DEVELOPMENTAL DELAY PREVENTION ACTIVITIES, DEPENDENT CHILD OF CLIENT, PER 15    Dev delay prev dp ch, 15 min00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
H2037002004MINUTES                                                                                                                                                                                                                                                                                                              
J0120001003INJECTION, TETRACYCLINE, UP TO 250 MG                                           Tetracyclin injection       51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0128001003INJECTION, ABARELIX, 10 MG                                                      Abarelix injection          51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J0130001003INJECTION ABCIXIMAB, 10 MG                                                      Abciximab injection         51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N                           
J0132001003INJECTION, ACETYLCYSTEINE, 100 MG                                               Acetylcysteine injection    51      A                                                                                                     C                          O1E 1P     02006010120060101        A                           
J0133001003INJECTION, ACYCLOVIR, 5 MG                                                      Acyclovir injection         51      A                                                                                                     C                          O1E 1P     02006010120060101        A                           
J0135001003INJECTION, ADALIMUMAB, 20 MG                                                    Adalimumab injection        51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J0150001003INJECTION, ADENOSINE FOR THERAPEUTIC USE,  6 MG (NOT TO BE USED TO REPORT ANY   Injection adenosine 6 MG    51      A                  2049                                                                               D                          O1E 1P     01994010120050101        N                           
J0150002004ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270)                                                                                                                                                                                                                                                                    
J0151001003INJECTION, ADENOSINE, 90 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE   Adenosine injection         51      A                  2049                                                      J0152                    D                          O1E 1P     0199901012004010120031231N                           
J0151002004COMPOUNDS, INSTEAD USE A9270)                                                                                                                                                                                                                                                                                        
J0152001003INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY    Adenosine injection         51      A                                                                                                     C                          O1E 1P     02004010120050101        N                           
J0152002004ADENOSINE PHOSPHATE COMPOUNDS; INSTEAD USE A9270)                                                                                                                                                                                                                                                                    
J0170001003INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE                            Adrenalin epinephrin inject 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0180001003INJECTION, AGALSIDASE BETA, 1 MG                                                Agalsidase beta injection   51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J0190001003INJECTION, BIPERIDEN LACTATE, PER 5 MG                                          Inj biperiden lactate/5 mg  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0200001003INJECTION, ALATROFLOXACIN MESYLATE, 100 MG                                      Alatrofloxacin mesylate     51      A                  2049.5                                                                             D                          O1E 1P     02000010120000101        N                           
J0205001003INJECTION, ALGLUCERASE, PER 10 UNITS                                            Alglucerase injection       51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N                           
J0207001003INJECTION, AMIFOSTINE, 500 MG                                                   Amifostine                  51      A                  2049                                                                               D                          O1D 1P     01998010119980101        N                           
J0210001003INJECTION, METHYLDOPATE  HCL, UP TO 250 MG                                      Methyldopate hcl injection  51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J0215001003INJECTION, ALEFACEPT, 0.5 MG                                                    Alefacept                   51      A                                                                                                     C                          O1E 1G     02004010120040101        N                           
J0256001003INJECTION, ALPHA 1 - PROTEINASE INHIBITOR - HUMAN, 10 MG                        Alpha 1 proteinase inhibitor51      A                  2049                                                                               D                          O1E 1P     01989010119990101        N                           
J0270001003INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE WHEN DRUG       Alprostadil for injection   51      A                  2049                                                                               D                          O1E 1      01997010120000101        N                           
J0270002004ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG                                                                                                                                                                                                                                      
J0270003004IS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                                
J0275001003ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRUG       Alprostadil urethral suppos 51      A                  2049                                                                               D                          O1E 1      01999010120000101        N                           
J0275002004ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG                                                                                                                                                                                                                                      
J0275003004IS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                                
J0278001003INJECTION, AMIKACIN SULFATE, 100 MG                                             Amikacin sulfate injection  51      A                                                                                                     C                          O1E 1P     02006010120060101        A                           
J0280001003INJECTION, AMINOPHYLLIN, UP TO 250 MG                                           Aminophyllin 250 MG inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J0282001003INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG                                      Amiodarone HCl              51      A                  2049                                                                               D                          O1E 1P     02001010120010101        N                           
J0285001003INJECTION, AMPHOTERICIN B, 50 MG                                                Amphotericin B              51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N                           
J0286001003INJECTION, AMPHOTERICIN B, ANY LIPID FORMULATION, 50 MG                         Amphotericin B lipid complex51      A                  2049                                                                               D                          O1E 1P     0199901012003010120021231N                           
J0287001003INJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG                                  Amphotericin b lipid complex51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J0288001003INJECTION, AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG                    Ampho b cholesteryl sulfate 51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J0289001003INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG                                       Amphotericin b liposome inj 51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J0290001003INJECTION, AMPICILLIN SODIUM,  500 MG                                           Ampicillin 500 MG inj       51      A                  2049                                                                               D                          O1E 1P     01984010120000101        N                           
J0295001003INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM                       Ampicillin sodium per 1.5 gm51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J0300001003INJECTION, AMOBARBITAL, UP TO 125 MG                                            Amobarbital 125 MG inj      51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0330001003INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG                                Succinycholine chloride inj 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0350001003INJECTION, ANISTREPLASE, PER 30 UNITS                                           Injection anistreplase 30 u 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0360001003INJECTION, HYDRALAZINE HCL, UP TO 20 MG                                         Hydralazine hcl injection   51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0365001003INJECTION, APROTONIN, 10,000 KIU                                                Aprotonin, 10,000 kiu       51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J0380001003INJECTION, METARAMINOL BITARTRATE, PER 10 MG                                    Inj metaraminol bitartrate  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0390001003INJECTION, CHLOROQUINE HYDROCHLORIDE, UP TO 250 MG                              Chloroquine injection       51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0395001003INJECTION, ARBUTAMINE HCL, 1 MG                                                 Arbutamine HCl injection    51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N                           
J0456001003INJECTION, AZITHROMYCIN, 500 MG                                                 Azithromycin                51      A                  2049.5                                                                             D                          O1E 1P     02000010120000101        N                           
J0460001003INJECTION, ATROPINE SULFATE, UP TO 0.3 MG                                       Atropine sulfate injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0470001003INJECTION, DIMERCAPROL, PER 100 MG                                              Dimecaprol injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0475001003INJECTION, BACLOFEN, 10 MG                                                      Baclofen 10 MG injection    51      A                  2049                                                                               D                          O1E 1P     01994010119970101        N                           
J0476001003INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL                               Baclofen intrathecal trial  51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N                           
J0480001003INJECTION, BASILIXIMAB, 20 MG                                                   Basiliximab                 51      A                  2049                                                                               D                      0095O1E 1G     02006010120060101        A                           
J0500001003INJECTION, DICYCLOMINE HCL, UP TO 20 MG                                         Dicyclomine injection       51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0515001003INJECTION, BENZTROPINE MESYLATE, PER 1 MG                                       Inj benztropine mesylate    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0520001003INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE, UP TO 5 MG          Bethanechol chloride inject 51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J0530001003INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 600,000     Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0530002004UNITS                                                                                                                                                                                                                                                                                                                
J0540001003INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 1,200,000   Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0540002004UNITS                                                                                                                                                                                                                                                                                                                
J0550001003INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 2,400,000   Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0550002004UNITS                                                                                                                                                                                                                                                                                                                
J0560001003INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS                         Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0570001003INJECTION, PENICILLIN G BENZATHINE, UP TO 1,200,000 UNITS                       Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0580001003INJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000 UNITS                       Penicillin g benzathine inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0583001003INJECTION, BIVALIRUDIN, 1 MG                                                    Bivalirudin                 51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J0585001003BOTULINUM TOXIN TYPE A, PER UNIT                                                Botulinum toxin a per unit  51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N                           
J0587001003BOTULINUM TOXIN TYPE B, PER 100 UNITS                                           Botulinum toxin type B      51      A                  2049                                                                               D                          O1E 1P     02002010120020101        N                           
J0592001003INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG                                  Buprenorphine hydrochloride 51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J0595001003INJECTION, BUTORPHANOL TARTRATE, 1 MG                                           Butorphanol tartrate 1 mg   51      A                                                                                                     C                          O1E 1      02004010120040101        N                           
J0600001003INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG                              Edetate calcium disodium inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0610001003INJECTION, CALCIUM GLUCONATE, PER 10 ML                                         Calcium gluconate injection 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0620001003INJECTION, CALCIUM GLYCEROPHOSPHATE AND CALCIUM LACTATE, PER 10 ML              Calcium glycer & lact/10 ML 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0630001003INJECTION, CALCITONIN SALMON, UP TO 400 UNITS                                   Calcitonin salmon injection 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0635001003INJECTION, CALCITRIOL, 1 MCG AMP.                                               Calcitriol injection        51      A                  2049                                                                               D                          O1E 1P     0199201012003010120021231N                           
J0636001003INJECTION, CALCITRIOL, 0.1 MCG                                                  Inj calcitriol per 0.1 mcg  51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J0637001003INJECTION, CASPOFUNGIN ACETATE, 5 MG                                            Caspofungin acetate         51      A                                                                                                     C                          O1E 1P     02003010120030101        N                           
J0640001003INJECTION, LEUCOVORIN CALCIUM, PER 50 MG                                        Leucovorin calcium injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0670001003INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML                                 Inj mepivacaine HCL/10 ml   51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0690001003INJECTION, CEFAZOLIN SODIUM, 500 MG                                             Cefazolin sodium injection  51      A                  2049                                                                               D                          O1E 1P     01982010120000101        N                           
J0692001003INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG                                       Cefepime HCl for injection  51      A                                                                                                     C                          O1E 1P     02002010120020101        N                           
J0694001003INJECTION, CEFOXITIN SODIUM, 1 GM                                               Cefoxitin sodium injection  51      A                  2049                                                      Q0090                    D                          O1E 1P     01992010119970101        N                           
J0696001003INJECTION, CEFTRIAXONE SODIUM, PER 250 MG                                       Ceftriaxone sodium injection51      A                  2049                                                                               D                          O1E 1P     01990010119970101        N                           
J0697001003INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG                                Sterile cefuroxime injection51      A                  2049                                                                               D                          O1E 1P     01990010119970101        N                           
J0698001003INJECTION, CEFOTAXIME SODIUM, PER GM                                            Cefotaxime sodium injection 51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N                           
J0702001003INJECTION, BETAMETHASONE ACETATE AND BETAMETHASONE SODIUM PHOSPHATE, PER 3 MG   Betamethasone acet&sod phosp51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J0704001003INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG                             Betamethasone sod phosp/4 MG51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J0706001003INJECTION, CAFFEINE CITRATE, 5MG                                                Caffeine citrate injection  51      A                                                                                                     C                          O1E 1P     02002010120020101        N                           
J0710001003INJECTION, CEPHAPIRIN SODIUM, UP TO 1 GM                                        Cephapirin sodium injection 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0713001003INJECTION, CEFTAZIDIME, PER 500 MG                                              Inj ceftazidime per 500 mg  51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J0715001003INJECTION, CEFTIZOXIME SODIUM, PER 500 MG                                       Ceftizoxime sodium / 500 MG 51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J0720001003INJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 GM                         Chloramphenicol sodium injec51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0725001003INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS                          Chorionic gonadotropin/1000u51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0735001003INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG                                        Clonidine hydrochloride     51      A                  2049                                                                               D                          O1E 1P     01998010119980101        N                           
J0740001003INJECTION, CIDOFOVIR, 375 MG                                                    Cidofovir injection         51      A                  2049                                                                               D                          O1E 1P     01998010119980101        N                           
J0743001003INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG                              Cilastatin sodium injection 51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N                           
J0744001003INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG                       Ciprofloxacin iv            51      A                                                                                                     C                          O1E 1P     02002010120020101        N                           
J0745001003INJECTION, CODEINE PHOSPHATE, PER 30 MG                                         Inj codeine phosphate /30 MG51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0760001003INJECTION, COLCHICINE, PER 1MG                                                  Colchicine injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0770001003INJECTION, COLISTIMETHATE SODIUM, UP TO 150 MG                                  Colistimethate sodium inj   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0780001003INJECTION, PROCHLORPERAZINE, UP TO 10 MG                                        Prochlorperazine injection  51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J0795001003INJECTION, CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM                           Corticorelin ovine triflutal51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J0800001003INJECTION, CORTICOTROPIN, UP TO 40 UNITS                                        Corticotropin injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0835001003INJECTION, COSYNTROPIN, PER 0.25 MG                                             Inj cosyntropin per 0.25 MG 51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J0850001003INJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMAN), PER VIAL        Cytomegalovirus imm IV /vial51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0878001003INJECTION, DAPTOMYCIN, 1 MG                                                     Daptomycin injection        51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J0880001003INJECTION, DARBEPOETIN ALFA, 5 MCG                                              Darbepoetin alfa injection  51      A                                                                                                     C                          O1E 1P     0200301012006010120051231D                           
J0881001003INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)                         Darbepoetin alfa, non-esrd  57      A                  4273.1                                                                             D                          O1E 1L     02006010120060101        A                           
J0882001003INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS)                 Darbepoetin alfa, esrd use  57      A                  4273.1                                                                             D                          O1E 1L     02006010120060101        A                           
J0885001003INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS                         Epoetin alfa, non-esrd      51      A                  2049                                                                               D                          O1E 9      02006010120060101        A                           
J0886001003INJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS)                      Epoetin alfa, esrd          57      A                  4273.1                                                                             D                          O1E 1L     02006010120060101        A                           
J0895001003INJECTION, DEFEROXAMINE MESYLATE, 500 MG                                        Deferoxamine mesylate inj   51      A                  2049                                                      Q0087                    D                          O1E 1P     01992010120010101        N                           
J0900001003INJECTION, TESTOSTERONE ENANTHATE AND ESTRADIOL VALERATE, UP TO 1 CC            Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0945001003INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG                                   Brompheniramine maleate inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0970001003INJECTION, ESTRADIOL VALERATE, UP TO 40 MG                                      Estradiol valerate injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1000001003INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG                                 Depo-estradiol cypionate inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1020001003INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG                                    Methylprednisolone 20 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1030001003INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG                                    Methylprednisolone 40 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1040001003INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG                                    Methylprednisolone 80 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1050001003INJECTION, MEDROXYPROGESTERONE ACETATE, 100 MG                                  Medroxyprogesterone inj     51      A                  2049                                                                               D                          O1E 1P     0198201012003010120021231N                           
J1051001003INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG                                   Medroxyprogesterone inj     51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J1055001003INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE, 150 MG            Medrxyprogester acetate inj 00      9                                          1862A1                                                     S                          O1E 1P     01994010119970101        N                           
J1056001003INJECTION, MEDROXYPROGESTERONE ACETATE / ESTRADIOL CYPIONATE, 5MG / 25MG        MA/EC contraceptiveinjection51      A                                                                                                     C                          O1E 1P     02002010120030101        N                           
J1060001003INJECTION, TESTOSTERONE CYPIONATE AND ESTRADIOL CYPIONATE, UP TO 1 ML           Testosterone cypionate 1 ML 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1070001003INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG                                 Testosterone cypionat 100 MG51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1080001003INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG                                 Testosterone cypionat 200 MG51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1094001003INJECTION, DEXAMETHASONE ACETATE, 1 MG                                          Inj dexamethasone acetate   51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J1095001003INJECTION, DEXAMETHASONE ACETATE, PER 8 MG                                      Inj dexamethasone acetate   51      A                  2049                                                                               D                          O1E 1P     0199601012003010120021231N                           
J1100001003INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG                                  Dexamethasone sodium phos   51      A                  2049                                                                               D                          O1E 1P     01982010120010101        N                           
J1110001003INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG                                 Inj dihydroergotamine mesylt51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1120001003INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG                                   Acetazolamid sodium injectio51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1160001003INJECTION, DIGOXIN, UP TO 0.5 MG                                                Digoxin injection           51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1162001003INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL                                 Digoxin immune fab (ovine)  51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J1165001003INJECTION, PHENYTOIN SODIUM, PER 50 MG                                          Phenytoin sodium injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1170001003INJECTION, HYDROMORPHONE, UP TO 4 MG                                            Hydromorphone injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1180001003INJECTION, DYPHYLLINE, UP TO 500 MG                                             Dyphylline injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1190001003INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG                                Dexrazoxane HCl injection   51      A                  2049                                                                               D                          O1E 1P     01997010119970101        N                           
J1200001003INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG                                     Diphenhydramine hcl injectio51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1205001003INJECTION, CHLOROTHIAZIDE SODIUM, PER 500 MG                                    Chlorothiazide sodium inj   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1212001003INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML                                 Dimethyl sulfoxide 50% 50 ML51      A45-23             2049                                                                               D                          O1E 1P     01986010119970101        N                           
J1230001003INJECTION, METHADONE HCL, UP TO 10 MG                                           Methadone injection         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1240001003INJECTION, DIMENHYDRINATE, UP TO 50 MG                                          Dimenhydrinate injection    51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1245001003INJECTION, DIPYRIDAMOLE, PER 10 MG                                              Dipyridamole injection      51      A                  15030   2049                                                                       D                          O1E 1P     01993010119980101        N                           
J1250001003INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG                                 Inj dobutamine HCL/250 mg   51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J1260001003INJECTION, DOLASETRON MESYLATE, 10 MG                                           Dolasetron mesylate         51      A                  2049                                                                               D                          O1D 1P     01999010120000101        N                           
J1265001003INJECTION, DOPAMINE HCL, 40 MG                                                  Dopamine injection          51      A                                                                                                     C                          O1E 1P     02006010120060101        A                           
J1270001003INJECTION, DOXERCALCIFEROL, 1 MCG                                               Injection, doxercalciferol  51      A                                                                                                     C                          O1E 1P     02002010120020101        N                           
J1320001003INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG                                       Amitriptyline injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1325001003INJECTION, EPOPROSTENOL, 0.5 MG                                                 Epoprostenol injection      51      A                  2049                                                                               D                          O1E 1P     01998010119980101        N                           
J1327001003INJECTION, EPTIFIBATIDE, 5 MG                                                   Eptifibatide injection      51      A                  2049                                                                               D                          O1E 1P     02000010120000101        N                           
J1330001003INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG                                     Ergonovine maleate injection51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J1335001003INJECTION, ERTAPENEM SODIUM, 500 MG                                             Ertapenem injection         51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J1364001003INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG                                Erythro lactobionate /500 MG51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J1380001003INJECTION, ESTRADIOL VALERATE, UP TO 10 MG                                      Estradiol valerate 10 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1390001003INJECTION, ESTRADIOL VALERATE, UP TO 20 MG                                      Estradiol valerate 20 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1410001003INJECTION, ESTROGEN  CONJUGATED, PER 25 MG                                      Inj estrogen conjugate 25 MG51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1430001003INJECTION, ETHANOLAMINE OLEATE, 100 MG                                          Ethanolamine oleate 100 mg  51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J1435001003INJECTION, ESTRONE, PER 1 MG                                                    Injection estrone per 1 MG  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1436001003INJECTION, ETIDRONATE DISODIUM, PER 300 MG                                      Etidronate disodium inj     51      A                  2049                                                                               D                          O1E 1P     01990010119970101        N                           
J1438001003INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG           Etanercept injection        51      A                  2049                                                                               D                          O1E 1P     02000010120000101        N                           
J1438002004ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG                                                                                                                                                                                                                                      
J1438003004IS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                                
J1440001003INJECTION, FILGRASTIM (G-CSF), 300 MCG                                          Filgrastim 300 mcg injection51      A                  2049                                                                               D                          O1E 1P     01994010119970101        N                           
J1441001003INJECTION, FILGRASTIM (G-CSF), 480 MCG                                          Filgrastim 480 mcg injection51      A                  2049                                                                               D                          O1E 1P     01994010119970101        N                           
J1450001003INJECTION FLUCONAZOLE, 200 MG                                                   Fluconazole                 51      A                  2049.5                                                                             D                          O1E 1P     02000010120000101        N                           
J1451001003INJECTION, FOMEPIZOLE, 15 MG                                                    Fomepizole, 15 mg           51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J1452001003INJECTION, FOMIVIRSEN SODIUM, INTRAOCULAR, 1.65 MG                              Intraocular Fomivirsen na   51      A                  2049.3                                                                             D                          O1E 1P     02001010120010101        N                           
J1455001003INJECTION, FOSCARNET SODIUM, PER 1000 MG                                        Foscarnet sodium injection  51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N                           
J1457001003INJECTION, GALLIUM NITRATE, 1 MG                                                Gallium nitrate injection   51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J1460001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC                                  Gamma globulin 1 CC inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1470001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC                                  Gamma globulin 2 CC inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1480001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC                                  Gamma globulin 3 CC inj     51      A                  2049                                                                               D                          O1E 1P     01985010119970101        N                           
J1490001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC                                  Gamma globulin 4 CC inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1500001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC                                  Gamma globulin 5 CC inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1510001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC                                  Gamma globulin 6 CC inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1520001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC                                  Gamma globulin 7 CC inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1530001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC                                  Gamma globulin 8 CC inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1540001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC                                  Gamma globulin 9 CC inj     51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1550001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC                                 Gamma globulin 10 CC inj    51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1560001003INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC                            Gamma globulin > 10 CC inj  51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1561001003INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 500 MG                                 Immune globulin 500 mg      51      A                  2049                                                                               D                          O1E 1P     0199001012003010120021231N                           
J1563001003INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 1G                                     IV immune globulin          00      9                                                                                                     I                          O1E 1P     0200101012006010120051231D                           
J1564001003INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 10 MG                                  Immune globulin 10 mg       00      9                                                                                                     I                          O1E 1P     0200301012006010120051231D                           
J1565001003INJECTION, RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN, INTRAVENOUS, 50 MG      RSV-ivig                    51      A                  2049                                                                               D                          O1E 1P     01998010119980101        N                           
J1566001003INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. POWDER), 500 MG      Immune globulin, powder     51      A                  2049                                                                               D                          O1E 1P     02006010120060101        A                           
J1567001003INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG  Immune globulin, liquid     51      A                  2049                                                                               D                          O1E 1P     02006010120060101        A                           
J1570001003INJECTION, GANCICLOVIR SODIUM, 500 MG                                           Ganciclovir sodium injection51      A                  2049                                                                               D                          O1E 1P     01994010119970101        N                           
J1580001003INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG                                   Garamycin gentamicin inj    51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1590001003INJECTION, GATIFLOXACIN, 10MG                                                   Gatifloxacin injection      51      A                                                                                                     C                          O1E 1P     02002010120020101        N                           
J1595001003INJECTION, GLATIRAMER ACETATE, 20 MG                                            Injection glatiramer acetate51      A                  2049                                                                               D                          O1E 1P     02004010120040101        N                           
J1600001003INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG                                  Gold sodium thiomaleate inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1610001003INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG                                     Glucagon hydrochloride/1 MG 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J1620001003INJECTION, GONADORELIN HYDROCHLORIDE, PER 100 MCG                               Gonadorelin hydroch/ 100 mcg51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1626001003INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG                                   Granisetron HCl injection   51      A                  2049                                                                               D                          O1E 1P     01998010119980101        N                           
J1630001003INJECTION, HALOPERIDOL, UP TO 5 MG                                              Haloperidol injection       51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J1631001003INJECTION, HALOPERIDOL DECANOATE, PER 50 MG                                     Haloperidol decanoate inj   51      A                  2049                                                                               D                          O1E 1P     01989010119970101        N                           
J1640001003INJECTION, HEMIN, 1 MG                                                          Hemin, 1 mg                 51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J1642001003INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS                   Inj heparin sodium per 10 u 51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J1644001003INJECTION, HEPARIN SODIUM, PER 1000 UNITS                                       Inj heparin sodium per 1000u51      A                  2049                                                                               D                          O1E 1LP    01995010120030101        N                           
J1645001003INJECTION, DALTEPARIN SODIUM, PER 2500 IU                                       Dalteparin sodium           51      A                  2049                                                                               D                          O1E 1P     01997010120020701        N                           
J1650001003INJECTION, ENOXAPARIN SODIUM, 10 MG                                             Inj enoxaparin sodium       51      A                                                                                                     C                          O1E 1P     01996010120040101        N                           
J1652001003INJECTION, FONDAPARINUX SODIUM, 0.5 MG                                          Fondaparinux sodium         51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J1655001003INJECTION, TINZAPARIN SODIUM, 1000 IU                                           Tinzaparin sodium injection 51      A                                                                                                     C                          O1E 1P     02002010120020701        N                           
J1670001003INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS                      Tetanus immune globulin inj 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J1675001003INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS                                     Histrelin acetate           51      A                  2049                                                                               D                      0095O1E 1G     02006010120060101        A                           
J1700001003INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG                                  Hydrocortisone acetate inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1710001003INJECTION, HYDROCORTISONE SODIUM  PHOSPHATE, UP TO 50 MG                        Hydrocortisone sodium ph inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1720001003INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG                        Hydrocortisone sodium succ i51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1730001003INJECTION, DIAZOXIDE, UP TO 300 MG                                              Diazoxide injection         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1742001003INJECTION, IBUTILIDE FUMARATE, 1 MG                                             Ibutilide fumarate injection51      A                  2049                                                                               D                          O1E 1P     01998010119980101        N                           
J1745001003INJECTION INFLIXIMAB, 10 MG                                                     Infliximab injection        51      A                  2049                                                                               D                          O1E 1P     02000010120000101        N                           
J1750001003INJECTION, IRON DEXTRAN, 50 MG                                                  Iron dextran                51      A                  2049.5                                                                             D                          O1E 1P     0200001012006010120051231D                           
J1751001003INJECTION, IRON DEXTRAN 165, 50 MG                                              Iron dextran 165 injection  51      A                                                                                                     D                      0123O1E 1P     02006010120060101        A                           
J1752001003INJECTION, IRON DEXTRAN 267, 50 MG                                              Iron dextran 267 injection  51      A                                                                                                     D                      0123O1E 1P     02006010120060101        A                           
J1755001003INJECTION, IRON SUCROSE, 20MG                                                   Iron sucrose injection      51      A                                                                                                     C                          O1E 1P     0200201012003010120021231N                           
J1756001003INJECTION, IRON SUCROSE, 1 MG                                                   Iron sucrose injection      51      A                                                                                                     C                          O1E 1P     02003010120030101        N                           
J1785001003INJECTION, IMIGLUCERASE, PER UNIT                                               Injection imiglucerase /unit51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J1790001003INJECTION, DROPERIDOL, UP TO 5 MG                                               Droperidol injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1800001003INJECTION, PROPRANOLOL HCL, UP TO 1 MG                                          Propranolol injection       51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1810001003INJECTION, DROPERIDOL AND FENTANYL CITRATE, UP TO 2 ML AMPULE                   Droperidol/fentanyl inj     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1815001003INJECTION, INSULIN, PER 5 UNITS                                                 Insulin injection           51      A60-14             2049                                                                               D                          O1E 1P     02003010120030101        N                           
J1817001003INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS        Insulin for insulin pump use51      A                                                                                                     C                          D1G 1P     02003010120030101        N                           
J1820001003INJECTION, INSULIN, UP TO 100 UNITS                                             Insulin injection           51      A60-14             2049                                                      J1815                    D                          O1E 1P     0198601012003010120021231N                           
J1825001003INJECTION, INTERFERON BETA-1A, 33 MCG                                           Interferon beta-1a          00      9                                                                                                     I                          O1E 1      01998010120030101        N                           
J1830001003INJECTION 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      01982010120000101        N                           
J1830002004ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR  USE WHEN                                                                                                                                                                                                                                          
J1830003004DRUG IS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                           
J1835001003INJECTION, ITRACONAZOLE, 50 MG                                                  Itraconazole injection      51      A                                                                                                     C                          O1E 1P     02002010120020101        N                           
J1840001003INJECTION, KANAMYCIN SULFATE, UP TO 500 MG                                      Kanamycin sulfate 500 MG inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1850001003INJECTION, KANAMYCIN SULFATE, UP TO 75 MG                                       Kanamycin sulfate 75 MG inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1885001003INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG                                    Ketorolac tromethamine inj  51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N                           
J1890001003INJECTION, CEPHALOTHIN SODIUM, UP TO 1 GRAM                                     Cephalothin sodium injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1910001003INJECTION, KUTAPRESSIN, UP TO 2 ML                                              Kutapressin injection       51      A                  2049                                                                               D                          O1E 1P     0198601012004010120031231N                           
J1931001003INJECTION, LARONIDASE, 0.1 MG                                                   Laronidase injection        51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J1940001003INJECTION, FUROSEMIDE, UP TO 20 MG                                              Furosemide injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1945001003INJECTION, LEPIRUDIN, 50 MG                                                     Lepirudin                   51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J1950001003INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG               Leuprolide acetate /3.75 MG 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J1955001003INJECTION, LEVOCARNITINE, PER 1 GM                                              Inj levocarnitine per 1 gm  51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J1956001003INJECTION, LEVOFLOXACIN, 250 MG                                                 Levofloxacin injection      51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N                           
J1960001003INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG                                     Levorphanol tartrate inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1980001003INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG                                   Hyoscyamine sulfate inj     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1990001003INJECTION, CHLORDIAZEPOXIDE HCL, UP TO 100 MG                                   Chlordiazepoxide injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2000001003INJECTION, LIDOCAINE HCL, 50 CC                                                 Lidocaine injection         51      A                  2049                                                                               D                          O1E 1P     0198601012004010120031231N                           
J2001001003INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG                        Lidocaine injection         51      A                  2049                                                                               D                          O1E 1P     02004010120040101        N                           
J2010001003INJECTION, LINCOMYCIN HCL, UP TO 300 MG                                         Lincomycin injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2020001003INJECTION, LINEZOLID, 200MG                                                     Linezolid injection         51      A                                                                                                     C                          O1E 1P     02002010120020101        N                           
J2060001003INJECTION, LORAZEPAM, 2 MG                                                      Lorazepam injection         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2150001003INJECTION, MANNITOL, 25% IN 50 ML                                               Mannitol injection          51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2175001003INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG                                 Meperidine hydrochl /100 MG 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2180001003INJECTION, MEPERIDINE AND PROMETHAZINE HCL, UP TO 50 MG                         Meperidine/promethazine inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2185001003INJECTION, MEROPENEM, 100 MG                                                    Meropenem                   51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J2210001003INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG                               Methylergonovin maleate inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2250001003INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG                                    Inj midazolam hydrochloride 51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J2260001003INJECTION, MILRINONE LACTATE, 5 MG                                              Inj milrinone lactate / 5 MG51      A                  2049                                                                               D                          O1E 1P     01986010120010101        N                           
J2270001003INJECTION, MORPHINE SULFATE, UP TO 10 MG                                        Morphine sulfate injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2271001003INJECTION, MORPHINE SULFATE, 100MG                                              Morphine so4 injection 100mg51      A60-14a            2049                                                                               D                          O1E 1P     01999010120010101        N                           
J2275001003INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE SOLUTION), PER 10 MG     Morphine sulfate injection  51      A60-14b            2049                                                                               D                          O1E 1P     01993010120010101        N                           
J2278001003INJECTION, ZICONOTIDE, 1 MICROGRAM                                              Ziconotide injection        51      A                                                                                                     D                      0123O1E 1P     02006010120060101        A                           
J2280001003INJECTION, MOXIFLOXACIN, 100 MG                                                 Inj, moxifloxacin 100 mg    51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J2300001003INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG                                  Inj nalbuphine hydrochloride51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J2310001003INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG                                     Inj naloxone hydrochloride  51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J2320001003INJECTION, NANDROLONE DECANOATE, UP TO 50 MG                                    Nandrolone decanoate 50 MG  51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2321001003INJECTION, NANDROLONE DECANOATE, UP TO 100 MG                                   Nandrolone decanoate 100 MG 51      A                  2049                                                                               D                          O1E 1P     01987010119970101        N                           
J2322001003INJECTION, NANDROLONE DECANOATE, UP TO 200 MG                                   Nandrolone decanoate 200 MG 51      A                  2049                                                                               D                          O1E 1P     01987010119970101        N                           
J2324001003INJECTION, NESIRITIDE, 0.25 MG                                                  Nesiritide                  51      A                  2049                                                                               D                          O1E 1P     0200301012006010120051231D                           
J2325001003INJECTION, NESIRITIDE, 0.1 MG                                                   Nesiritide injection        51      A                  2049                                                                               D                          O1E 1P     02006010120060101        A                           
J2352001003INJECTION, OCTREOTIDE ACETATE, 1 MG                                             Octreotide acetate injection51      A                  2049                                                                               D                          O1E 1P     0200001012004010120031231N                           
J2353001003INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG             Octreotide injection, depot 51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J2354001003INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS           Octreotide inj, non-depot   51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J2354002004INJECTION, 25 MCG                                                                                                                                                                                                                                                                                                    
J2355001003INJECTION, OPRELVEKIN, 5 MG                                                     Oprelvekin injection        51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N                           
J2357001003INJECTION, OMALIZUMAB, 5 MG                                                     Omalizumab injection        51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J2360001003INJECTION, ORPHENADRINE CITRATE, UP TO 60 MG                                    Orphenadrine injection      51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2370001003INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML                                        Phenylephrine hcl injection 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2400001003INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30 ML                              Chloroprocaine hcl injection51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2405001003INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG                                  Ondansetron hcl injection   51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N                           
J2410001003INJECTION, OXYMORPHONE HCL, UP TO 1 MG                                          Oxymorphone hcl injection   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2425001003INJECTION, PALIFERMIN, 50 MICROGRAMS                                            Palifermin injection        51      A                                                                                                     C                          O1E 1P     02006010120060101        A                           
J2430001003INJECTION, PAMIDRONATE DISODIUM, PER 30 MG                                      Pamidronate disodium /30 MG 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2440001003INJECTION, PAPAVERINE HCL, UP TO 60 MG                                          Papaverin hcl injection     51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2460001003INJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG                                     Oxytetracycline injection   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2469001003INJECTION, PALONOSETRON HCL, 25 MCG                                             Palonosetron HCl            51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J2500001003INJECTION, PARICALCITOL, 5 MCG                                                  Paricalcitol                51      A                  2049                                                                               D                          O1E 1P     0200001012003010120021231N                           
J2501001003INJECTION, PARICALCITOL, 1 MCG                                                  Paricalcitol                51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J2503001003INJECTION, PEGAPTANIB SODIUM, 0.3 MG                                            Pegaptanib sodium injection 51      A                                                                                                     C                      0095O1E 1P     02006010120060101        A                           
J2504001003INJECTION, PEGADEMASE BOVINE, 25 IU                                             Pegademase bovine, 25 iu    51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J2505001003INJECTION, PEGFILGRASTIM, 6 MG                                                  Injection, pegfilgrastim 6mg53      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J2510001003INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS                  Penicillin g procaine inj   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2513001003INJECTION, PENTASTARCH, 10% SOLUTION, 100 ML                                    Pentastarch 10% solution    51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J2515001003INJECTION, PENTOBARBITAL SODIUM, PER 50 MG                                      Pentobarbital sodium inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2540001003INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS                          Penicillin g potassium inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2543001003INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125     Piperacillin/tazobactam     51      A                  2049                                                                               D                          O1E 1P     02000010120010101        N                           
J2543002004GRAMS)                                                                                                                                                                                                                                                                                                               
J2545001003PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, PER 300 MG, ADMINISTERED THROUGH  Pentamidine isethionte/300mg51      A                  2049                                                                               D                      0018D1G 1P     01992010119970101        N                           
J2545002004A DME                                                                                                                                                                                                                                                                                                                
J2550001003INJECTION, PROMETHAZINE HCL, UP TO 50 MG                                        Promethazine hcl injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2560001003INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG                                   Phenobarbital sodium inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2590001003INJECTION, OXYTOCIN, UP TO 10 UNITS                                             Oxytocin injection          51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2597001003INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG                                      Inj desmopressin acetate    51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J2650001003INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML                                     Prednisolone acetate inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2670001003INJECTION, TOLAZOLINE HCL, UP TO 25 MG                                          Totazoline hcl injection    51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2675001003INJECTION, PROGESTERONE, PER 50 MG                                              Inj progesterone per 50 MG  51      A                  2049                                                                               D                          O1E 1P     01986010120020701        N                           
J2680001003INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG                                  Fluphenazine decanoate 25 MG51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2690001003INJECTION, PROCAINAMIDE HCL, UP TO 1 GM                                         Procainamide hcl injection  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2700001003INJECTION, OXACILLIN SODIUM, UP TO 250 MG                                       Oxacillin sodium injeciton  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2710001003INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG                              Neostigmine methylslfte inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2720001003INJECTION, PROTAMINE SULFATE, PER 10 MG                                         Inj protamine sulfate/10 MG 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2725001003INJECTION, PROTIRELIN, PER 250 MCG                                              Inj protirelin per 250 mcg  51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J2730001003INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM                                     Pralidoxime chloride inj    51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2760001003INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG                                    Phentolaine mesylate inj    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2765001003INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG                                      Metoclopramide hcl injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2770001003INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350)                          Quinupristin/dalfopristin   51      A                  2049                                                                               D                          O1E 1P     02001010120010101        N                           
J2780001003INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG                                      Ranitidine hydrochloride inj51      A                  2049                                                                               D                          O1E 1P     02000010120000101        N                           
J2783001003INJECTION, RASBURICASE, 0.5 MG                                                  Rasburicase                 51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J2788001003INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MCG                       Rho d immune globulin 50 mcg51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J2790001003INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MCG                     Rho d immune globulin inj   51      A                  2049                                                                               D                          O1E 1P     01986010120030101        N                           
J2792001003INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU Rho(D) immune globulin h, sd51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N                           
J2794001003INJECTION, RISPERIDONE, LONG ACTING, 0.5 MG                                     Risperidone, long acting    51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J2795001003INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG                                      Ropivacaine HCl injection   51      A                                                                                                     C                          O1E 1P     02001010120010101        N                           
J2800001003INJECTION, METHOCARBAMOL, UP TO 10 ML                                           Methocarbamol injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2805001003INJECTION, SINCALIDE, 5 MICROGRAMS                                              Sincalide injection         51      A                                                                                                     C                          O1E 1P     02006010120060101        A                           
J2810001003INJECTION, THEOPHYLLINE, PER 40 MG                                              Inj theophylline per 40 MG  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2820001003INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG                                        Sargramostim injection      51      A                  2049                                                                               D                          O1E 1P     01982010119980101        N                           
J2850001003INJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM                              Inj secretin synthetic human51      A                  2049                                                                               D                          O1E 1P     02006010120060101        A                           
J2910001003INJECTION, AUROTHIOGLUCOSE, UP TO 50 MG                                         Aurothioglucose injeciton   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2912001003INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML                                      Sodium chloride injection   51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2915001003INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 62.5 MG        NA Ferric Gluconate Complex 51      A                  2049.2  2049.4                                                                     D                          O1E 1P     0200101012003010120021231N                           
J2916001003INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG        Na ferric gluconate complex 51      A                  2049.2  2049.4                                                                     D                          O1E 1P     02003010120030101        N                           
J2920001003INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG                     Methylprednisolone injection51      A                  2049                                                                               D                          O1E 1G     01982010119970101        N                           
J2930001003INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG                    Methylprednisolone injection51      A                  2049                                                                               D                          O1E 1G     01984010119970101        N                           
J2940001003INJECTION, SOMATREM, 1 MG                                                       Somatrem injection          51      A                  2049                    1861s2b                                                    D                          O1E 1P     02002010120020101        N                           
J2941001003INJECTION, SOMATROPIN, 1 MG                                                     Somatropin injection        51      A                  2049                    1861s2b                                                    D                          O1E 1P     02002010120020101        N                           
J2950001003INJECTION, PROMAZINE HCL, UP TO 25 MG                                           Promazine hcl injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2993001003INJECTION, RETEPLASE, 18.1 MG                                                   Reteplase injection         51      A                  2049                                                                               D                          O1E 1P     02001010120010101        N                           
J2995001003INJECTION, STREPTOKINASE, PER 250,000 IU                                        Inj streptokinase /250000 IU51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2997001003INJECTION, ALTEPLASE RECOMBINANT, 1 MG                                          Alteplase recombinant       51      A                  2049                                                                               D                          O1E 1P     02001010120010101        N                           
J3000001003INJECTION, STREPTOMYCIN, UP TO 1 GM                                             Streptomycin injection      51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3010001003INJECTION, FENTANYL CITRATE, 0.1 MG                                             Fentanyl citrate injeciton  51      A                  2049                                                                               D                          O1E 1P     01982010120010101        N                           
J3030001003INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG Sumatriptan succinate / 6 MG51      A                  2049                                                                               D                          O1E 1P     01986010120000101        N                           
J3030002004ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG                                                                                                                                                                                                                                      
J3030003004IS SELF ADMINISTERED)                                                                                                                                                                                                                                                                                                
J3070001003INJECTION, PENTAZOCINE, 30 MG                                                   Pentazocine injection       51      A                  2049                                                                               D                          O1E 1P     01982010120030101        N                           
J3100001003INJECTION, TENECTEPLASE, 50MG                                                   Tenecteplase injection      51      A                                                                                                     C                          O1E 1P     02002010120020101        N                           
J3105001003INJECTION, TERBUTALINE SULFATE, UP TO 1 MG                                      Terbutaline sulfate inj     51      A                  2049                                                                               D                          O1E 1P     01987010119970101        N                           
J3110001003INJECTION, TERIPARATIDE, 10 MCG                                                 Teriparatide injection      51      A                                                                                                     D                      0120O1E 1P     02005010120050101        N                           
J3120001003INJECTION, TESTOSTERONE ENANTHATE, UP TO 100 MG                                 Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3130001003INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG                                 Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3140001003INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG                                 Testosterone suspension inj 51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3150001003INJECTION, TESTOSTERONE PROPIONATE, UP TO 100 MG                                Testosteron propionate inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3230001003INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG                                      Chlorpromazine hcl injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3240001003INJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIAL                   Thyrotropin injection       51      A                  2049                                                                               D                          O1E 1P     01986010120030101        N                           
J3245001003INJECTION, TIROFIBAN HYDROCHLORIDE, 12.5 MG                                     Tirofiban hydrochloride     51      A                  2049                                                                               D                          O1E 1P     0200001012005010120041231N                           
J3246001003INJECTION, TIROFIBAN HCL, 0.25MG                                                Tirofiban HCl               51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J3250001003INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG                                  Trimethobenzamide hcl inj   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3260001003INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG                                      Tobramycin sulfate injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3265001003INJECTION, TORSEMIDE, 10 MG/ML                                                  Injection torsemide 10 mg/ml51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J3280001003INJECTION, THIETHYLPERAZINE MALEATE, UP TO 10 MG                                Thiethylperazine maleate inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3285001003INJECTION, TREPROSTINIL, 1 MG                                                   Treprostinil injection      51      A                                                                                                     C                          O1E 1P     02006010120060101        A                           
J3301001003INJECTION, TRIAMCINOLONE  ACETONIDE, PER 10MG                                   Triamcinolone acetonide inj 51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N                           
J3302001003INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG                                     Triamcinolone diacetate inj 51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N                           
J3303001003INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG                                  Triamcinolone hexacetonl inj51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N                           
J3305001003INJECTION, TRIMETREXATE GLUCURONATE, PER 25 MG                                  Inj trimetrexate glucoronate51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J3310001003INJECTION, PERPHENAZINE, UP TO 5 MG                                             Perphenazine injeciton      51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3315001003INJECTION, TRIPTORELIN PAMOATE, 3.75 MG                                         Triptorelin pamoate         51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J3320001003INJECTION, SPECTINOMYCIN DIHYDROCHLORIDE, UP TO 2 GM                            Spectinomycn di-hcl inj     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3350001003INJECTION, UREA, UP TO 40 GM                                                    Urea injection              51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J3355001003INJECTION, UROFOLLITROPIN, 75 IU                                                Urofollitropin, 75 iu       51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J3360001003INJECTION, DIAZEPAM, UP TO 5 MG                                                 Diazepam injection          51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3364001003INJECTION, UROKINASE, 5000 IU VIAL                                              Urokinase 5000 IU injection 51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N                           
J3365001003INJECTION, IV, UROKINASE, 250,000 I.U. VIAL                                     Urokinase 250,000 IU inj    51      A                  2049                                                      Q0089                    D                          O1E 1P     01992010119970101        N                           
J3370001003INJECTION, VANCOMYCIN HCL, 500 MG                                               Vancomycin hcl injection    51      A60-14             2049                                                                               D                          O1E 1P     01986010120000101        N                           
J3395001003INJECTION, VERTEPORFIN, 15MG                                                    Verteporfin injection       51      A35-10045-30                                                                                          D                          O1E 1P     0200201012005010120041231N                           
J3396001003INJECTION, VERTEPORFIN, 0.1 MG                                                  Verteporfin injection       51      A                  35-100  45-30                                                                      D                          O1E 9      02005010120050101        N                           
J3400001003INJECTION, TRIFLUPROMAZINE HCL, UP TO 20 MG                                     Triflupromazine hcl inj     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3410001003INJECTION, HYDROXYZINE HCL, UP TO 25 MG                                         Hydroxyzine hcl injection   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3411001003INJECTION, THIAMINE HCL, 100 MG                                                 Thiamine hcl 100 mg         51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J3415001003INJECTION, PYRIDOXINE HCL, 100 MG                                               Pyridoxine hcl 100 mg       51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J3420001003INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP  TO 1000 MCG                         Vitamin b12 injection       51      A45-4              2049                                                                               D                          O1E 1P     01986010119970101        N                           
J3430001003INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG                                   Vitamin k phytonadione inj  51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3465001003INJECTION, VORICONAZOLE, 10 MG                                                  Injection, voriconazole     51      A                  2049                                                                               D                          O1E 1P     02004010120040101        N                           
J3470001003INJECTION, HYALURONIDASE, UP TO 150 UNITS                                       Hyaluronidase injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J3471001003INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1 USP UNIT (UP TO 999   Ovine, up to 999 USP units  51      A                                                                                                     D                      0123O1E 1P     02006010120060101        A                           
J3471002004USP UNITS)                                                                                                                                                                                                                                                                                                           
J3472001003INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1000 USP UNITS          Ovine, 1000 USP units       51      A                                                                                                     D                      0123O1E 1P     02006010120060101        A                           
J3475001003INJECTION, MAGNESIUM SULFATE, PER 500 MG                                        Inj magnesium sulfate       51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J3480001003INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ                                        Inj potassium chloride      51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J3485001003INJECTION, ZIDOVUDINE, 10 MG                                                    Zidovudine                  51      A                  2049                                                                               D                          O1E 1P     02001010120010101        N                           
J3486001003INJECTION, ZIPRASIDONE MESYLATE, 10 MG                                          Ziprasidone mesylate        51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J3487001003INJECTION, ZOLEDRONIC ACID, 1 MG                                                Zoledronic acid             51      A                                                                                                     C                          O1E 1P     02003010120030101        N                           
J3490001003UNCLASSIFIED DRUGS                                                              Drugs unclassified injection51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J3520001003EDETATE DISODIUM, PER 150 MG                                                    Edetate disodium per 150 mg 00      935-64 45-20                                                                                          M                          O1E 1P     01986010119960101        N                           
J3530001003NASAL VACCINE INHALATION                                                        Nasal vaccine inhalation    51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J3535001003DRUG ADMINISTERED THROUGH A METERED DOSE INHALER                                Metered dose inhaler drug   00      9                  2050.5                                                                             M                          O1E 1P     01994010119970101        N                           
J3570001003LAETRILE, AMYGDALIN, VITAMIN B17                                                Laetrile amygdalin vit B17  00      945-10                                                                                                M                          O1E 1P     01986010119960101        N                           
J3590001003UNCLASSIFIED BIOLOGICS                                                          Unclassified biologics      51      A                                                                                                     C                          O1E 1P     02003010120030101        N                           
J7030001003INFUSION, NORMAL SALINE SOLUTION , 1000 CC                                      Normal saline solution infus51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J7040001003INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)                       Normal saline solution infus51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J70420010035% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)                                     5% dextrose/normal saline   51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J7050001003INFUSION, NORMAL SALINE SOLUTION , 250 CC                                       Normal saline solution infus51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J7051001003STERILE SALINE OR WATER, UP TO 5 CC                                             Sterile saline/water        51      A                  2049                                                                               D                          O1E 1P     0199401012006010120051231D                           
J70600010035% DEXTROSE/WATER (500 ML = 1 UNIT)                                             5% dextrose/water           51      A                  2049                                                                               D                          O1E 1P     01985010119970101        N                           
J7070001003INFUSION, D5W, 1000 CC                                                          D5w infusion                51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J7100001003INFUSION, DEXTRAN 40, 500 ML                                                    Dextran 40 infusion         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J7110001003INFUSION, DEXTRAN 75, 500 ML                                                    Dextran 75 infusion         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J7120001003RINGERS LACTATE INFUSION, UP TO 1000 CC                                         Ringers lactate infusion    51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J7130001003HYPERTONIC SALINE SOLUTION, 50 OR 100 MEQ, 20 CC VIAL                           Hypertonic saline solution  51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J7188001003INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU                             Inj Vonwillebrand factor iu 51      A35.30             2049.5                                                                             D                      0095O1E 1P     02006010120060101        A                           
J7189001003FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PER 1 MICROGRAM               Factor viia                 51      A                  2049                                                                               D                          O1E 1P     02006010120060101        A                           
J7190001003FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.                             Factor viii                 51      A                  2049                                                                               D                          O1E 1P     01986010119990101        N                           
J7191001003FACTOR VIII (ANTIHEMOPHILIC FACTOR (PORCINE)), PER I.U.                         Factor VIII (porcine)       51      A                  2049                                                                               D                          O1E 1P     01996010119980101        N                           
J7192001003FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.                       Factor viii recombinant     51      A                  2049                                                                               D                          O1E 1P     01994010119990101        N                           
J7193001003FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U.           Factor IX non-recombinant   51      A                  2049                                                                               D                          O1E 1P     02002010120020101        N                           
J7194001003FACTOR IX, COMPLEX, PER I.U.                                                    Factor ix complex           51      A                  2049                                                                               D                          O1E 1P     01986010119980101        N                           
J7195001003FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.                         Factor IX recombinant       51      A                  2049                                                                               D                          O1E 1P     02002010120020101        N                           
J7197001003ANTITHROMBIN III (HUMAN), PER I.U.                                              Antithrombin iii injection  51      A                  2049                                                                               D                          O1E 1P     01992010119970101        N                           
J7198001003ANTI-INHIBITOR, PER I.U.                                                        Anti-inhibitor              51      A45-24             2049                                                                               D                          O1E 1P     02000010120000101        N                           
J7199001003HEMOPHILIA CLOTTING FACTOR, NOT OTHERWISE CLASSIFIED                            Hemophilia clot factor noc  51      A45-24             2049                                                                               D                          O1E 1P     02000010120000101        N                           
J7300001003INTRAUTERINE COPPER CONTRACEPTIVE                                               Intraut copper contraceptive00      9                                          1862A1                                                     S                          P6C 9      01986010119950401        N                           
J7302001003LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM, 52 MG               Levonorgestrel iu contracept00      9                                          1862a1                                                     S                          P6C 9      02002010120020101        N                           
J7303001003CONTRACEPTIVE SUPPLY, HORMONE CONTAINING VAGINAL RING, EACH                     Contraceptive vaginal ring  00      9                                          1862.1                                                     S                          Z2  9      02004010120040101        N                           
J7304001003CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH                            Contraceptive hormone patch 00      9                                          1862.1                                                     S                          Z2  9      02005010120050101        N                           
J7306001003LEVONORGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLANTS AND SUPPLIES  Levonorgestrel implant sys  00      9                                                                                                     I                          P6C 9      02006010120060101        A                           
J7308001003AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOSAGE     Aminolevulinic acid hcl top 51      A                                                                                                     C                          O1E 1      02002010120040101        N                           
J7308002004FORM (354 MG)                                                                                                                                                                                                                                                                                                        
J7310001003GANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT                                        Ganciclovir long act implant51      A                  2049                                                                               D                          O1E 9      01997010119970101        N                           
J7316001003SODIUM HYALURONATE, 5 MG FOR INTRA-ARTICULAR INJECTION                          Sodium hyaluronate injection00      9                                                                            J7317                    I                          O1E 1      0200201012003010120021231N                           
J7317001003SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR INJECTION          Sodium hyaluronate injection51      A                                                                                                     C                          O1E 1      0200301012006010120051231D                           
J7318001003HYALURONAN (SODIUM HYALURONATE) OR DERIVATIVE, INTRA-ARTICULAR INJECTION, 1 MG  Hyaluron/deriv intra-art inj51      A                                                                                                     C                          O1E 1      02006010120060101        A                           
J7320001003HYLAN G-F 20, 16 MG, FOR INTRA ARTICULAR INJECTION                              Hylan G-F 20 injection      51      A                                                                                                     C                          O1E 1      0199901012006010120051231D                           
J7330001003AUTOLOGOUS CULTURED CHONDROCYTES, IMPLANT                                       Cultured chondrocytes implnt57      A                                                                                                     C                          O1E 1P     02001010120020701        N                           
J7340001003DERMAL AND EPIDERMAL, (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT      Metabolic active D/E tissue 51      A                                                                                                     C                          O1E 1      02002010120060101        C                           
J7340002004BIOENGINEERED OR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER                                                                                                                                                                                                                                         
J7340003004SQUARE CENTIMETER                                                                                                                                                                                                                                                                                                    
J7341001003DERMAL (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER           Non-human, metabolic tissue 51      A                                                                                                     C                          O1E 1      02006010120060101        A                           
J7341002004BIOENGINEERED OR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER                                                                                                                                                                                                                                         
J7341003004SQUARE CENTIMETER                                                                                                                                                                                                                                                                                                    
J7342001003DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED Metabolically active tissue 46      A                                                                                                     C                          O1E 1      02003010120060101        C                           
J7342002004OR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER                                                                                                                                                                                                                                     
J7343001003DERMAL AND EPIDERMAL, (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT  Nonmetabolic act d/e tissue 51      A                                                                                                     C                          O1E 1      02005010120060101        C                           
J7343002004OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE                                                                                                                                                                                                                                              
J7343003004ELEMENTS, PER SQUARE CENTIMETER                                                                                                                                                                                                                                                                                      
J7344001003DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED Nonmetabolic active tissue  51      A                                                                                                     C                          O1E 1      02005010120060101        C                           
J7344002004OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE                                                                                                                                                                                                                                             
J7344003004CENTIMETER                                                                                                                                                                                                                                                                                                           
J7350001003DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, INJECTABLE, WITH OR WITHOUT OTHER   Injectable human tissue     51      A                                                                                                     C                          O1E 1S     02003010120060101        C                           
J7350002004BIOENGINEERED OR PROCESSED ELEMENTS, BUT WITHOUT METABOLIZED ACTIVE ELEMENTS,                                                                                                                                                                                                                                        
J7350003004PER 10 MG                                                                                                                                                                                                                                                                                                            
J7500001003AZATHIOPRINE, ORAL, 50 MG                                                       Azathioprine oral 50mg      51      A                  2049.5                                                                             D                          O1E 1G     01988010120000101        N                           
J7501001003AZATHIOPRINE, PARENTERAL, 100 MG                                                Azathioprine parenteral     51      A                  2049                                                                               D                          O1E 1G     01988010120000101        N                           
J7502001003CYCLOSPORINE, ORAL, 100 MG                                                      Cyclosporine oral 100 mg    57      A                  2049.5                                                                             D                          O1E 1G     02000010120000101        N                           
J7504001003LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, EQUINE, PARENTERAL, 250 MG  Lymphocyte immune globulin  51      A45-22             2049                                                                               D                          O1E 1G     01988010120020101        N                           
J7505001003MUROMONAB-CD3, PARENTERAL, 5 MG                                                 Monoclonal antibodies       51      A                  2049                                                                               D                          O1E 1G     01988010120010101        N                           
J7506001003PREDNISONE, ORAL, PER 5MG                                                       Prednisone oral             51      A                  2049.5                                                                             D                          O1E 1G     01989010120000101        N                           
J7507001003TACROLIMUS, ORAL, PER 1 MG                                                      Tacrolimus oral per 1 MG    51      A                  2049.5                                                                             D                          O1E 1G     01995010120000101        N                           
J7508001003TACROLIMUS, ORAL, PER 5 MG                                                      Tacrolimus oral per 5 MG    51      A                  2049.5                                                                             D                          O1E 1G     0199501012004010120031231N                           
J7509001003METHYLPREDNISOLONE ORAL, PER 4 MG                                               Methylprednisolone oral     51      A                  2049.5                                                                             D                          O1E 1G     01996010120000101        N                           
J7510001003PREDNISOLONE ORAL, PER 5 MG                                                     Prednisolone oral per 5 mg  51      A                  2049.5                                                                             D                          O1E 1G     01996010120000101        N                           
J7511001003LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, 25MG    Antithymocyte globuln rabbit51      A                                                                                                     C                          O1E 1G     02002010120020101        N                           
J7513001003DACLIZUMAB, PARENTERAL, 25 MG                                                   Daclizumab, parenteral      51      A                  2049.5                                                                             D                          O1E 1G     01999010120000101        N                           
J7515001003CYCLOSPORINE, ORAL, 25 MG                                                       Cyclosporine oral 25 mg     51      A                                                                                                     C                          O1E 1G     02000010120000101        N                           
J7516001003CYCLOSPORIN, PARENTERAL, 250 MG                                                 Cyclosporin parenteral 250mg51      A                                                                                                     C                          O1E 1G     02000010120000101        N                           
J7517001003MYCOPHENOLATE MOFETIL, ORAL, 250 MG                                             Mycophenolate mofetil oral  51      A                                                                                                     C                          O1E 1G     02000010120000101        N                           
J7518001003MYCOPHENOLIC ACID, ORAL, 180 MG                                                 Mycophenolic acid           51      A                  2050.5  4471    5249                                                               D                          O1E 1G     02005010120050101        N                           
J7520001003SIROLIMUS, ORAL, 1 MG                                                           Sirolimus, oral             51      A                  2049.5                                                                             D                          O1E 1G     02001010120010101        N                           
J7525001003TACROLIMUS, PARENTERAL, 5 MG                                                    Tacrolimus injection        51      A                  2049.5                                                                             D                          O1E 1G     02001010120010101        N                           
J7599001003IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED                                Immunosuppressive drug noc  51      A                  2049.5                                                                             D                          O1E 1G     01996010120000101        N                           
J7608001003ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,   Acetylcysteine inh sol u d  51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7608002004PER GRAM                                                                                                                                                                                                                                                                                                             
J7611001003ALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 1  Albuterol concentrated form 51      A                  2100.5                                                                             D                          D1G 1P     02005010120050101        N                           
J7611002004MG                                                                                                                                                                                                                                                                                                                   
J7612001003LEVALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, CONCENTRATED FORM, Levalbuterol concentrated   51      A                  2100.5                                                                             D                          D1G 1P     02005010120050101        N                           
J76120020040.5 MG                                                                                                                                                                                                                                                                                                               
J7613001003ALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG       Albuterol unit dose         51      A                  2100.5                                                                             D                          D1G 1P     02005010120050101        N                           
J7614001003LEVALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG  Levalbuterol unit dose      51      A                  2100.5                                                                             D                          D1G 1P     02005010120050101        N                           
J7616001003ALBUTEROL, UP TO 5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED           Albuterol compound solution 51      A                  2100.5                                                                             D                          D1G 1P     0200501012006010120051231D                           
J7616002004INHALATION SOLUTION, ADMINISTERED THROUGH DME                                                                                                                                                                                                                                                                        
J7617001003LEVALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED      Levalbuterol compounded sol 51      A                  2100.5                                                                             D                          D1G 1P     0200501012006010120051231D                           
J7617002004INHALATION SOLUTION, ADMINISTERED THROUGH DME                                                                                                                                                                                                                                                                        
J7618001003ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION    Albuterol inh sol con       51      A                  2100.5                                                                             D                          D1G 1P     0200001012005010120041231N                           
J7618002004ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG                                                                                                                                                                                                                                      
J7618003004(LEVALBUTEROL)                                                                                                                                                                                                                                                                                                       
J7619001003ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION    Albuterol inh sol u d       51      A                  2100.5                                                                             D                          D1G 1P     0200001012005010120041231N                           
J7619002004ADMINISTERED THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG                                                                                                                                                                                                                                              
J7619003004(LEVALBUTEROL)                                                                                                                                                                                                                                                                                                       
J7620001003ALBUTEROL, 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     02006010120060101        A                           
J7620002004INHALATION SOLUTION, ADMINISTERED THROUGH DME                                                                                                                                                                                                                                                                        
J7621001003ALBUTEROL, ALL FORMULATIONS, INCLUDING SEPARATED ISOMERS, UP TO 5 MG            (Levo)albuterol/Ipra-bromide51      A                                                                                                     C                          D1G 1P     0200401012005010120041231N                           
J7621002004(ALBUTEROL) OR 2.5 MG (LEVOALBUTEROL), AND IPRATROPIUM BROMIDE, UP TO 1 MG,                                                                                                                                                                                                                                          
J7621003004COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME                                                                                                                                                                                                                                                             
J7622001003BECLOMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,   Beclomethasone inhalatn sol 51      A                                                                                                     C                          D1G 1P     02002010120020701        N                           
J7622002004PER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J7624001003BETAMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,    Betamethasone inhalation sol51      A                                                                                                     C                          D1G 1P     02002010120020701        N                           
J7624002004PER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J7626001003BUDESONIDE INHALATION SOLUTION, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT  Budesonide, non-compounded  51      A                                                                                                     C                          D1G 1P     02002010120060101        C                           
J7626002004DOSE FORM, UP TO 0.5 MG                                                                                                                                                                                                                                                                                              
J7627001003BUDESONIDE, POWDER, COMPOUNDED FOR INHALATION SOLUTION, ADMINISTERED THROUGH    Budesonide, compounded      51      A                                                                                                     C                          D1G 1P     02006010120060101        A                           
J7627002004DME, UNIT DOSE FORM, UP TO 0.5 MG                                                                                                                                                                                                                                                                                    
J7628001003BITOLTEROL MESYLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED Bitolterol mes inhal sol con51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7628002004FORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J7629001003BITOLTEROL MESYLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE    Bitolterol mes inh sol u d  51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7629002004FORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J7631001003CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,  Cromolyn sodium inh sol u d 51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7631002004PER 10 MILLIGRAMS                                                                                                                                                                                                                                                                                                    
J7633001003BUDESONIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM,    Budesonide concentrated sol 51      A                                                                                                     C                          D1G 1P     02003010120030101        N                           
J7633002004PER 0.25 MILLIGRAM                                                                                                                                                                                                                                                                                                   
J7635001003ATROPINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER  Atropine inhal sol con      51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7635002004MILLIGRAM                                                                                                                                                                                                                                                                                                            
J7636001003ATROPINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER     Atropine inhal sol unit dose51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7636002004MILLIGRAM                                                                                                                                                                                                                                                                                                            
J7637001003DEXAMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, Dexamethasone inhal sol con 51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7637002004PER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J7638001003DEXAMETHASONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,    Dexamethasone inhal sol u d 51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7638002004PER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J7639001003DORNASE ALPHA, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,    Dornase alpha inhal sol u d 51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7639002004PER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J7640001003FORMORTEROL, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, 12   Formorterol injection       00      9                                                                                                     I                          D1G 1P     02006010120060101        A                           
J7640002004MICROGRAMS                                                                                                                                                                                                                                                                                                           
J7641001003FLUNISOLIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE, PER       Flunisolide, inhalation sol 51      A                                                                                                     C                          D1G 1P     02002010120020701        N                           
J7641002004MILLIGRAM                                                                                                                                                                                                                                                                                                            
J7642001003GLYCOPYRROLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED      Glycopyrrolate inhal sol con51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7642002004FORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J7643001003GLYCOPYRROLATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,   Glycopyrrolate inhal sol u d51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7643002004PER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J7644001003IPRATROPIUM BROMIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE    Ipratropium brom inh sol u d51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7644002004FORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J7648001003ISOETHARINE HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED     Isoetharine hcl inh sol con 51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7648002004FORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J7649001003ISOETHARINE HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,  Isoetharine hcl inh sol u d 51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7649002004PER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J7658001003ISOPROTERENOL HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED   Isoproterenolhcl inh sol con51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7658002004FORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J7659001003ISOPROTERENOL HCL, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE      Isoproterenol hcl inh sol ud51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7659002004FORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J7668001003METAPROTERENOL SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME,           Metaproterenol inh sol con  51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7668002004CONCENTRATED FORM, PER 10 MILLIGRAMS                                                                                                                                                                                                                                                                                 
J7669001003METAPROTERENOL SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE Metaproterenol inh sol u d  51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7669002004FORM, PER 10 MILLIGRAMS                                                                                                                                                                                                                                                                                              
J7674001003METHACHOLINE CHLORIDE ADMINISTERED AS INHALATION SOLUTION THROUGH A NEBULIZER,  Methacholine chloride, neb  51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J7674002004PER 1 MG                                                                                                                                                                                                                                                                                                             
J7680001003TERBUTALINE SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED Terbutaline so4 inh sol con 51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7680002004FORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J7681001003TERBUTALINE SULFATE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE    Terbutaline so4 inh sol u d 51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7681002004FORM, PER MILLIGRAM                                                                                                                                                                                                                                                                                                  
J7682001003TOBRAMYCIN, UNIT DOSE FORM, 300 MG, INHALATION SOLUTION, ADMINISTERED THROUGH   Tobramycin inhalation sol   51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7682002004DME                                                                                                                                                                                                                                                                                                                  
J7683001003TRIAMCINOLONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, Triamcinolone inh sol con   51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7683002004PER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J7684001003TRIAMCINOLONE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM,    Triamcinolone inh sol u d   51      A                  2100.5                                                                             D                          D1G 1P     02000010120020701        N                           
J7684002004PER MILLIGRAM                                                                                                                                                                                                                                                                                                        
J7699001003NOC DRUGS, INHALATION SOLUTION ADMINISTERED THROUGH DME                         Inhalation solution for DME 51      A                  2100.5                                                                             D                          D1G 1P     01993010120020701        N                           
J7799001003NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME                Non-inhalation drug for DME 51      A                  2100.5                                                                             D                          D1G 1P     01993010120020701        N                           
J8498001003ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED                    Antiemetic rectal/supp NOS  51      A                                          1861s2T                                                    D                          O1D 1      02006010120060101        A                           
J8499001003PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS                              Oral prescrip drug non chemo00      9                  2049                                                                               M                          O1E 1P     01995010119970101        N                           
J8501001003APREPITANT, ORAL, 5 MG                                                          Oral aprepitant             51      A                                                                                                     D                      0119O1E 1G     02005010120050101        N                           
J8510001003BUSULFAN; ORAL, 2 MG                                                            Oral busulfan               51      A                  2049.5                                                                             D                          O1D 1P     02000010120000101        N                           
J8515001003CABERGOLINE, ORAL, 0.25 MG                                                      Cabergoline, oral 0.25mg    00      9                  2049.5                                                                             M                          O1E 1P     02006010120060101        A                           
J8520001003CAPECITABINE, ORAL, 150 MG                                                      Capecitabine, oral, 150 mg  51      A                  2049.5                                                                             D                          O1D 1P     02000010120000101        N                           
J8521001003CAPECITABINE, ORAL, 500 MG                                                      Capecitabine, oral, 500 mg  51      A                  2049.5                                                                             D                          O1D 1P     02000010120000101        N                           
J8530001003CYCLOPHOSPHAMIDE; ORAL, 25 MG                                                   Cyclophosphamide oral 25 MG 51      A                  2049.5                                                                             D                          O1D 1GP    01995010119970831        N                           
J8540001003DEXAMETHASONE, ORAL, 0.25 MG                                                    Oral dexamethasone          51      A                                          1861(s)2T                                                  D                          O1E 1      02006010120060101        A                           
J8560001003ETOPOSIDE; ORAL, 50 MG                                                          Etoposide oral 50 MG        51      A                  2049.5                                                                             D                          O1D 1P     01995010119970101        N                           
J8565001003GEFITINIB, ORAL, 250 MG                                                         Gefitinib oral              00      9                                                                                                     I                          O1E 9      02005010120050101        N                           
J8597001003ANTIEMETIC DRUG, ORAL, NOT OTHERWISE SPECIFIED                                  Antiemetic drug oral NOS    51      A                                          1861s2T                                                    D                          O1D 1      02006010120060101        A                           
J8600001003MELPHALAN; ORAL, 2 MG                                                           Melphalan oral 2 MG         51      A                  2049.5                                                                             D                          O1D 1P     01995010119970101        N                           
J8610001003METHOTREXATE; ORAL, 2.5 MG                                                      Methotrexate oral 2.5 MG    51      A                  2049.5                                                                             D                          O1D 1GP    01995010119970831        N                           
J8700001003TEMOZOLOMIDE, ORAL, 5 MG                                                        Temozolomide                51      A                  2049.5C                                                                            D                          O1D 1P     02001010120010101        N                           
J8999001003PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS                                  Oral prescription drug chemo51      A                  2049.5                                                                             D                          O1D 1P     01995010119970101        N                           
J9000001003DOXORUBICIN HCL, 10 MG                                                          Doxorubic hcl 10 MG vl chemo51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9001001003DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG                        Doxorubicin hcl liposome inj51      A                  2049                                                                               D                          O1E 1P     02000010120000101        N                           
J9010001003ALEMTUZUMAB, 10 MG                                                              Alemtuzumab injection       51      A                                          1833T                                                      D                          O1E 1P     02003010120030101        N                           
J9015001003ALDESLEUKIN, PER SINGLE USE VIAL                                                Aldesleukin/single use vial 51      A                  2049                                                                               D                          O1D 1P     01996010119970101        N                           
J9017001003ARSENIC TRIOXIDE, 1MG                                                           Arsenic trioxide            51      A                                                                                                     C                          O1D 1P     02002010120020101        N                           
J9020001003ASPARAGINASE, 10,000 UNITS                                                      Asparaginase injection      51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9025001003INJECTION, AZACITIDINE, 1 MG                                                    Azacitidine injection       51      A                                                                                                     C                          O1D 1P     02006010120060101        A                           
J9027001003INJECTION, CLOFARABINE, 1 MG                                                    Clofarabine injection       51      A                                                                                                     C                          O1E 1P     02006010120060101        A                           
J9031001003BCG (INTRAVESICAL) PER INSTILLATION                                             Bcg live intravesical vac   51      A                  2049                                                                               D                          O1D 1P     01991010119970101        N                           
J9035001003INJECTION, BEVACIZUMAB, 10 MG                                                   Bevacizumab injection       51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J9040001003BLEOMYCIN SULFATE, 15 UNITS                                                     Bleomycin sulfate injection 51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9041001003INJECTION, BORTEZOMIB, 0.1 MG                                                   Bortezomib injection        51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J9045001003CARBOPLATIN, 50 MG                                                              Carboplatin injection       51      A                  2049                                                                               D                          O1D 1P     01990010119970101        N                           
J9050001003CARMUSTINE, 100 MG                                                              Carmus bischl nitro inj     51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9055001003INJECTION, CETUXIMAB, 10 MG                                                     Cetuximab injection         51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J9060001003CISPLATIN, POWDER OR S0LUTION, PER 10 MG                                        Cisplatin 10 MG injection   51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9062001003CISPLATIN, 50 MG                                                                Cisplatin 50 MG injection   51      A                  2049                                                                               D                          O1D 1P     01982010119970101        N                           
J9065001003INJECTION, CLADRIBINE, PER 1 MG                                                 Inj cladribine per 1 MG     51      A                  2049                                                                               D                          O1D 1P     01995010119970101        N                           
J9070001003CYCLOPHOSPHAMIDE, 100 MG                                                        Cyclophosphamide 100 MG inj 51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9080001003CYCLOPHOSPHAMIDE, 200 MG                                                        Cyclophosphamide 200 MG inj 51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9090001003CYCLOPHOSPHAMIDE, 500 MG                                                        Cyclophosphamide 500 MG inj 51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9091001003CYCLOPHOSPHAMIDE, 1.0 GRAM                                                      Cyclophosphamide 1.0 grm inj51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9092001003CYCLOPHOSPHAMIDE, 2.0 GRAM                                                      Cyclophosphamide 2.0 grm inj51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9093001003CYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG                                           Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     01988010119970101        N                           
J9094001003CYCLOPHOSPHAMIDE, LYOPHILIZED, 200 MG                                           Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9095001003CYCLOPHOSPHAMIDE, LYOPHILIZED, 500 MG                                           Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9096001003CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM                                         Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9097001003CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM                                         Cyclophosphamide lyophilized51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9098001003CYTARABINE LIPOSOME, 10 MG                                                      Cytarabine liposome         51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J9100001003CYTARABINE, 100 MG                                                              Cytarabine hcl 100 MG inj   51      A                  2049                                                                               D                          O1D 1P     01986010119970101        N                           
J9110001003CYTARABINE, 500 MG                                                              Cytarabine hcl 500 MG inj   51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9120001003DACTINOMYCIN, 0.5 MG                                                            Dactinomycin actinomycin d  51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9130001003DACARBAZINE, 100 MG                                                             Dacarbazine 100 mg inj      51      A                  2049                                                                               D                          O1D 1P     01986010120040101        N                           
J9140001003DACARBAZINE, 200 MG                                                             Dacarbazine 200 MG inj      51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9150001003DAUNORUBICIN, 10 MG                                                             Daunorubicin                51      A                  2049                                                                               D                          O1D 1P     01986010119980101        N                           
J9151001003DAUNORUBICIN CITRATE, LIPOSOMAL FORMULATION, 10 MG                              Daunorubicin citrate liposom51      A                  2049                                                                               D                          O1D 1P     01999010119990101        N                           
J9160001003DENILEUKIN DIFTITOX, 300 MCG                                                    Denileukin diftitox, 300 mcg51      A                                                                                                     C                          O1E 1P     02001010120010101        N                           
J9165001003DIETHYLSTILBESTROL DIPHOSPHATE, 250 MG                                          Diethylstilbestrol injection51      A                  2049                                                                               D                          O1D 1P     01988010119970101        N                           
J9170001003DOCETAXEL, 20 MG                                                                Docetaxel                   51      A                  2049                                                                               D                          O1D 1P     01998010119980101        N                           
J9175001003INJECTION, ELLIOTTS' B SOLUTION, 1 ML                                           Elliotts b solution per ml  51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        A                           
J9178001003INJECTION, EPIRUBICIN HCL, 2 MG                                                 Inj, epirubicin hcl, 2 mg   51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J9180001003EPIRUBICIN HYDROCHLORIDE, 50 MG                                                 Epirubicin HCl injection    51      A                  2049                                                                               D                          O1D 1P     0200101012004010120031231N                           
J9181001003ETOPOSIDE, 10 MG                                                                Etoposide 10 MG inj         51      A                  2049                                                                               D                          O1D 1P     01987010119970101        N                           
J9182001003ETOPOSIDE, 100 MG                                                               Etoposide 100 MG inj        51      A                  2049                                                                               D                          O1D 1P     01987010119970101        N                           
J9185001003FLUDARABINE PHOSPHATE, 50 MG                                                    Fludarabine phosphate inj   51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9190001003FLUOROURACIL, 500 MG                                                            Fluorouracil injection      51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9200001003FLOXURIDINE, 500 MG                                                             Floxuridine injection       51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9201001003GEMCITABINE HCL, 200 MG                                                         Gemcitabine HCl             51      A                  2049                                                                               D                          O1D 1P     01998010119980101        N                           
J9202001003GOSERELIN ACETATE IMPLANT, PER 3.6 MG                                           Goserelin acetate implant   51      A                  2049                                                                               D                          O1D 1P     01991010119970101        N                           
J9206001003IRINOTECAN, 20 MG                                                               Irinotecan injection        51      A                  2049                                                                               D                          O1D 1P     01998010119980101        N                           
J9208001003IFOSFAMIDE, 1 GM                                                                Ifosfomide injection        51      A                  2049                                                                               D                          O1D 1P     01990010119970101        N                           
J9209001003MESNA, 200 MG                                                                   Mesna injection             51      A                  2049                                                                               D                          O1D 1P     01990010119970101        N                           
J9211001003IDARUBICIN HYDROCHLORIDE, 5 MG                                                  Idarubicin hcl injection    51      A                  2049                                                                               D                          O1D 1P     01993010119970101        N                           
J9212001003INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MCG                             Interferon alfacon-1        51      A                  2049                                                                               D                          O1E 1P     01999010119990101        N                           
J9213001003INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS                               Interferon alfa-2a inj      51      A                  2049                                                                               D                          O1D G      01993010119970101        N                           
J9214001003INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS                               Interferon alfa-2b inj      51      A                  2049                                                                               D                          O1D G      01993010119970101        N                           
J9215001003INTERFERON, ALFA-N3, (HUMAN LEUKOCYTE DERIVED), 250,000 IU                      Interferon alfa-n3 inj      51      A                  2049                                                                               D                          O1D G      01993010119970101        N                           
J9216001003INTERFERON, GAMMA 1-B, 3 MILLION UNITS                                          Interferon gamma 1-b inj    51      A                  2049                                                                               D                          O1D G      01993010119970101        N                           
J9217001003LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG                               Leuprolide acetate suspnsion51      A                  2049                                                                               D                          O1D 1P     01991010119970101        N                           
J9218001003LEUPROLIDE ACETATE, PER 1 MG                                                    Leuprolide acetate injeciton51      A                  2049                                                                               D                      0014O1D 1P     01990010119970101        N                           
J9219001003LEUPROLIDE ACETATE IMPLANT, 65 MG                                               Leuprolide acetate implant  51      A                  2049                                                                               D                          O1D 1P     02001010120010101        N                           
J9225001003HISTRELIN IMPLANT, 50 MG                                                        Histrelin implant           51      A                  2049                                                                               D                          O1D 1P     02006010120060101        A                           
J9230001003MECHLORETHAMINE HYDROCHLORIDE, (NITROGEN MUSTARD), 10 MG                        Mechlorethamine hcl inj     51      A                  2049                                                                               D                          O1D 1P     01986010119970101        N                           
J9245001003INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG                                       Inj melphalan hydrochl 50 MG51      A                  2049                                                                               D                          O1D 1P     01995010119970101        N                           
J9250001003METHOTREXATE SODIUM, 5 MG                                                       Methotrexate sodium inj     51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9260001003METHOTREXATE SODIUM, 50 MG                                                      Methotrexate sodium inj     51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9263001003INJECTION, OXALIPLATIN, 0.5 MG                                                  Oxaliplatin                 51      A                                                                                                     C                          O1D 1P     02004010120040101        N                           
J9264001003INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG                             Paclitaxel injection        51      A                                                                                                     C                          O1E 1P     02006010120060101        A                           
J9265001003PACLITAXEL, 30 MG                                                               Paclitaxel injection        51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9266001003PEGASPARGASE, PER SINGLE DOSE VIAL                                              Pegaspargase/singl dose vial51      A                  2049                                                                               D                          O1D 1P     01996010119970101        N                           
J9268001003PENTOSTATIN, PER 10 MG                                                          Pentostatin injection       51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9270001003PLICAMYCIN, 2.5 MG                                                              Plicamycin (mithramycin) inj51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9280001003MITOMYCIN, 5 MG                                                                 Mitomycin 5 MG inj          51      A                  2049                                                                               D                          O1D 1P     01986010119970101        N                           
J9290001003MITOMYCIN, 20 MG                                                                Mitomycin 20 MG inj         51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9291001003MITOMYCIN, 40 MG                                                                Mitomycin 40 MG inj         51      A                  2049                                                                               D                          O1D 1P     01989010119970101        N                           
J9293001003INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG                                 Mitoxantrone hydrochl / 5 MG51      A                  2049                                                                               D                          O1D 1P     01990010119970101        N                           
J9300001003GEMTUZUMAB OZOGAMICIN, 5MG                                                      Gemtuzumab ozogamicin       51      A                                                                                                     C                          O1D 1P     02002010120020101        N                           
J9305001003INJECTION, PEMETREXED, 10 MG                                                    Pemetrexed injection        51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J9310001003RITUXIMAB, 100 MG                                                               Rituximab cancer treatment  51      A                  2049                                                                               D                          O1D 1P     01999010119990101        N                           
J9320001003STREPTOZOCIN, 1 GM                                                              Streptozocin injection      51      A                  2049                                                                               D                          O1D 1P     01986010119970101        N                           
J9340001003THIOTEPA, 15 MG                                                                 Thiotepa injection          51      A                  2049                                                                               D                          O1D 1P     01984010119970101        N                           
J9350001003TOPOTECAN, 4 MG                                                                 Topotecan                   51      A                  2049                                                                               D                          O1D 1P     01998010119980101        N                           
J9355001003TRASTUZUMAB, 10 MG                                                              Trastuzumab                 51      A                                                                                                     C                          O1E 1P     02000010120000101        N                           
J9357001003VALRUBICIN, INTRAVESICAL, 200 MG                                                Valrubicin, 200 mg          51      A                  2049                                                                               D                          O1E 1P     02000010120000101        N                           
J9360001003VINBLASTINE SULFATE, 1 MG                                                       Vinblastine sulfate inj     51      A                  2049                                                                               D                          O1D 1P     01986010119970101        N                           
J9370001003VINCRISTINE SULFATE, 1 MG                                                       Vincristine sulfate 1 MG inj51      A                  2049                                                                               D                          O1D 1P     01986010119970101        N                           
J9375001003VINCRISTINE SULFATE, 2 MG                                                       Vincristine sulfate 2 MG inj51      A                  2049                                                                               D                          O1D 1P     01988010119970101        N                           
J9380001003VINCRISTINE SULFATE, 5 MG                                                       Vincristine sulfate 5 MG inj51      A                  2049                                                                               D                          O1D 1P     01994010119970101        N                           
J9390001003VINORELBINE TARTRATE, PER 10 MG                                                 Vinorelbine tartrate/10 mg  51      A                  2049                                                                               D                          O1D 1P     01996010119970101        N                           
J9395001003INJECTION, FULVESTRANT, 25 MG                                                   Injection, Fulvestrant      51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J9600001003PORFIMER SODIUM, 75 MG                                                          Porfimer sodium             51      A                  2049                                                                               D                          O1D 1P     01998010119980101        N                           
J9999001003NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS                                  Chemotherapy drug           51      A45-16             2049                                                                               D                          O1D 1P     01986010119970101        N                           
K0001001003STANDARD WHEELCHAIR                                                             Standard wheelchair         36      A                                                                                                     C                          D1D R      01994010119940101        N                           
K0002001003STANDARD HEMI (LOW SEAT) WHEELCHAIR                                             Stnd hemi (low seat) whlchr 36      A                                                                                                     C                          D1D R      01994010119940101        N                           
K0003001003LIGHTWEIGHT WHEELCHAIR                                                          Lightweight wheelchair      36      A                                                                                                     C                          D1D R      01994010119940101        N                           
K0004001003HIGH STRENGTH, LIGHTWEIGHT WHEELCHAIR                                           High strength ltwt whlchr   36      A                                                                                                     C                          D1D R      01994010119940101        N                           
K0005001003ULTRALIGHTWEIGHT WHEELCHAIR                                                     Ultralightweight wheelchair 32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0006001003HEAVY DUTY WHEELCHAIR                                                           Heavy duty wheelchair       36      A                                                                                                     C                          D1D R      01994010119940101        N                           
K0007001003EXTRA HEAVY DUTY WHEELCHAIR                                                     Extra heavy duty wheelchair 36      A                                                                                                     C                          D1D R      01994010119940101        N                           
K0009001003OTHER MANUAL WHEELCHAIR/BASE                                                    Other manual wheelchair/base46      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0010001003STANDARD - WEIGHT FRAME MOTORIZED/POWER WHEELCHAIR                              Stnd wt frame power whlchr  36      A                                                                                                     C                          D1D APR    01994010119970505        N                           
K0011001003STANDARD - WEIGHT FRAME MOTORIZED/POWER WHEELCHAIR WITH PROGRAMMABLE CONTROL    Stnd wt pwr whlchr w control36      A                                                                                                     C                          D1D APR    01994010119970505        N                           
K0011002004PARAMETERS FOR SPEED ADJUSTMENT, TREMOR DAMPENING, ACCELERATION CONTROL AND                                                                                                                                                                                                                                          
K0011003004BRAKING                                                                                                                                                                                                                                                                                                              
K0012001003LIGHTWEIGHT PORTABLE MOTORIZED/POWER WHEELCHAIR                                 Ltwt portbl power whlchr    36      A                                                                                                     C                          D1D APR    01994010119970505        N                           
K0014001003OTHER MOTORIZED/POWER WHEELCHAIR BASE                                           Other power whlchr base     36      A                                                                                                     C                          D1D APR    01994010120010101        N                           
K0015001003DETACHABLE, NON-ADJUSTABLE HEIGHT ARMREST, EACH                                 Detach non-adjus hght armrst32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0016001003DETACHABLE, ADJUSTABLE HEIGHT ARMREST, COMPLETE ASSEMBLY, EACH                  Detach adjust armrst cmplete32      A                                                                            E0973                    C                          D1D APR    0199401012004010120031231N                           
K0017001003DETACHABLE, ADJUSTABLE HEIGHT ARMREST, BASE, EACH                               Detach adjust armrest base  32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0018001003DETACHABLE, ADJUSTABLE HEIGHT ARMREST, UPPER PORTION, EACH                      Detach adjust armrst upper  32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0019001003ARM PAD, EACH                                                                   Arm pad each                32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0020001003FIXED, ADJUSTABLE HEIGHT ARMREST, PAIR                                          Fixed adjust armrest pair   32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0021001003ANTI-TIPPING DEVICE, EACH                                                       Anti-tipping device each    32      A                                                                            E0971                    C                          D1D APR    0199401012003010120021231N                           
K0022001003REINFORCED BACK UPHOLSTERY                                                      Reinforced back upholstery  32      A                                                                            E0982                    C                          D1D APR    0199401012004010120031231N                           
K0023001003SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, ATTACHED WITH STRAPS       Planr back insrt foam w/strp32      A                                                                                                     C                          D1D APR    0199401012005010120041231N                           
K0024001003SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, WITH ADJUSTABLE HOOK-ON    Plnr back insrt foam w/hrdwr32      A                                                                                                     C                          D1D APR    0199401012005010120041231N                           
K0024002004HARDWARE                                                                                                                                                                                                                                                                                                             
K0025001003HOOK-ON HEADREST EXTENSION                                                      Hook-on headrest extension  32      A                                                                            E0966                    C                          D1D APR    0199401012004010120031231N                           
K0026001003BACK UPHOLSTERY FOR ULTRALIGHTWEIGHT OR HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR    Back upholst lgtwt whlchr   32      A                                                                                                     C                          D1D APR    0199401012004010120031231N                           
K0027001003BACK UPHOLSTERY FOR WHEELCHAIR TYPE OTHER THAN ULTRALIGHTWEIGHT OR HIGH         Back upholst other whlchr   32      A                                                                                                     C                          D1D APR    0199401012004010120031231N                           
K0027002004STRENGTH LIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                                      
K0028001003MANUAL, FULLY RECLINING BACK                                                    Manual fully reclining back 32      A                                                                            E1226                    C                          D1D APR    0199401012004010120031231N                           
K0029001003REINFORCED SEAT UPHOLSTERY                                                      Reinforced seat upholstery  32      A                                                                                                     C                          D1D APR    0199401012004010120031231N                           
K0030001003SOLID SEAT INSERT, PLANAR SEAT, SINGLE DENSITY FOAM                             Solid plnr seat sngl dnsfoam32      A                                                                            E0992                    C                          D1D APR    0199401012004010120031231N                           
K0031001003SAFETY BELT/PELVIC STRAP, EACH                                                  Safety belt/pelvic strap    32      A                                                                                                     C                          D1D APR    0199401012004010120031231N                           
K0032001003SEAT UPHOLSTERY FOR ULTRALIGHTWEIGHT OR HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR    Seat uphols lgtwt whlchr    32      A                                                                                                     C                          D1D APR    0199401012004010120031231N                           
K0033001003SEAT UPHOLSTERY FOR WHEELCHAIR TYPE OTHER THAN ULTRALIGHTWEIGHT OR HIGH         Seat upholstery other whlchr32      A                                                                                                     C                          D1D APR    0199401012004010120031231N                           
K0033002004STRENGTH LIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                                      
K0034001003HEEL LOOP,EACH                                                                  Heel loop each              32      A                                                                            E0951                    C                          D1D APR    0199401012003010120021231N                           
K0035001003HEEL LOOP WITH ANKLE STRAP, EACH                                                Heel loop with ankle strap  32      A                                                                            E0951                    C                          D1D APR    0199401012004010120031231N                           
K0036001003TOE LOOP, EACH                                                                  Toe loop each               32      A                                                                            E0952                    C                          D1D APR    0199401012004010120031231N                           
K0037001003HIGH MOUNT FLIP-UP FOOTREST, EACH                                               High mount flip-up footrest 32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0038001003LEG STRAP, EACH                                                                 Leg strap each              32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0039001003LEG STRAP, H STYLE, EACH                                                        Leg strap h style each      32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0040001003ADJUSTABLE ANGLE FOOTPLATE, EACH                                                Adjustable angle footplate  32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0041001003LARGE SIZE FOOTPLATE, EACH                                                      Large size footplate each   32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0042001003STANDARD SIZE FOOTPLATE, EACH                                                   Standard size footplate each32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0043001003FOOTREST, LOWER EXTENSION TUBE, EACH                                            Ftrst lower extension tube  32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0044001003FOOTREST, UPPER HANGER BRACKET, EACH                                            Ftrst upper hanger bracket  32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0045001003FOOTREST, COMPLETE ASSEMBLY                                                     Footrest complete assembly  32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0046001003ELEVATING LEGREST, LOWER EXTENSION TUBE, EACH                                   Elevat legrst low extension 32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0047001003ELEVATING LEGREST, UPPER HANGER BRACKET, EACH                                   Elevat legrst up hangr brack32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0048001003ELEVATING LEGREST, COMPLETE ASSEMBLY                                            Elevate legrest complete    32      A                                                                            E0990                    C                          D1D APR    0199401012004010120031231N                           
K0049001003CALF PAD, EACH                                                                  Calf pad each               32      A                                                                            E0995                    C                          D1D APR    0199401012004010120031231N                           
K0050001003RATCHET ASSEMBLY                                                                Ratchet assembly            32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0051001003CAM RELEASE ASSEMBLY, FOOTREST OR LEGREST, EACH                                 Cam relese assem ftrst/lgrst32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0052001003SWINGAWAY, DETACHABLE FOOTRESTS, EACH                                           Swingaway detach footrest   32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0053001003ELEVATING FOOTRESTS, ARTICULATING (TELESCOPING), EACH                           Elevate footrest articulate 32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0054001003SEAT 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    0199401012004010120031231N                           
K0054002004OR ULTRALIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                                       
K0055001003SEAT DEPTH OF 15", 17", OR 18" FOR A HIGH STRENGTH, LIGHTWEIGHT OR              Seat dpth 15/17/18 ltwt wc  32      A                                                                                                     C                          D1D APR    0199401012004010120031231N                           
K0055002004ULTRALIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                                          
K0056001003SEAT HEIGHT LESS THAN  17" OR EQUAL TO  OR GREATER THAN 21" FOR A HIGH          Seat ht <17 or >=21 ltwt wc 32      A                                                                                                     C                          D1D APR    01994010119990101        N                           
K0056002004STRENGTH, LIGHTWEIGHT, OR ULTRALIGHTWEIGHT WHEELCHAIR                                                                                                                                                                                                                                                                
K0057001003SEAT WIDTH 19" OR 20" FOR HEAVY DUTY OR EXTRA HEAVY DUTY CHAIR                  Seat wdth 19/20 hvy dty wc  32      A                                                                                                     C                          D1D APR    0199401012004010120031231N                           
K0058001003SEAT DEPTH 17" OR 18" FOR MOTORIZED/POWER WHEELCHAIR                            Seat dpth 17/18 power wc    32      A                                                                                                     C                          D1D APR    0199401012004010120031231N                           
K0059001003PLASTIC COATED HANDRIM, EACH                                                    Plastic coated handrim each 32      A                                                                                                     C                          D1D APR    0199401012005010120041231N                           
K0060001003STEEL HANDRIM, EACH                                                             Steel handrim each          32      A                                                                                                     C                          D1D APR    0199401012005010120041231N                           
K0061001003ALUMINUM HANDRIM, EACH                                                          Aluminum handrim each       32      A                                                                                                     C                          D1D APR    0199401012005010120041231N                           
K0062001003HANDRIM WITH 8-10 VERTICAL OR OBLIQUE PROJECTIONS, EACH                         Handrim 8-10 vert/obliq proj32      A                                                                            E0967                    C                          D1D APR    0199401012004010120031231N                           
K0063001003HANDRIM WITH 12-16 VERTICAL OR OLBIQUE PROJECTIONS, EACH                        Hndrm 12-16 vert/obliq proj 32      A                                                                            E0967                    C                          D1D APR    0199401012004010120031231N                           
K0064001003ZERO PRESSURE TUBE (FLAT FREE INSERTS), ANY SIZE, EACH                          Zero pressure tube flat free32      A                                                                            E2213                    C                          D1D APR    0199401012006010120051231D                           
K0065001003SPOKE PROTECTORS, EACH                                                          Spoke protectors            32      A                                                                                                     C                          D1D APR    01994010120000101        N                           
K0066001003SOLID TIRE, ANY SIZE, EACH                                                      Solid tire any size each    32      A                                                                            E2220                    C                          D1D APR    0199401012006010120051231D                           
K0067001003PNEUMATIC TIRE, ANY SIZE, EACH                                                  Pneumatic tire any size each32      A                                                                            E2211                    C                          D1D APR    0199401012006010120051231D                           
K0068001003PNEUMATIC TIRE TUBE, EACH                                                       Pneumatic tire tube each    32      A                                                                            E2212                    C                          D1D APR    0199401012006010120051231D                           
K0069001003REAR WHEEL ASSEMBLY, COMPLETE, WITH SOLID TIRE, SPOKES OR MOLDED, EACH          Rear whl complete solid tire32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0070001003REAR WHEEL ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, SPOKES OR MOLDED, EACH      Rear whl compl pneum tire   32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0071001003FRONT CASTER ASSEMBLY, COMPLETE, WITH PNEUMATIC TIRE, EACH                      Front castr compl pneum tire32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0072001003FRONT CASTER ASSEMBLY, COMPLETE, WITH SEMI-PNEUMATIC TIRE, EACH                 Frnt cstr cmpl sem-pneum tir32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0073001003CASTER PIN LOCK,EACH                                                            Caster pin lock each        32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0074001003PNEUMATIC CASTER TIRE, ANY SIZE, EACH                                           Pneumatic caster tire each  32      A                                                                            E2214                    C                          D1D APR    0199401012006010120051231D                           
K0075001003SEMI-PNEUMATIC CASTER TIRE, ANY SIZE, EACH                                      Semi-pneumatic caster tire  32      A                                                                            E2219                    C                          D1D APR    0199401012006010120051231D                           
K0076001003SOLID CASTER TIRE, ANY SIZE, EACH                                               Solid caster tire each      32      A                                                                            E2221                    C                          D1D APR    0199401012006010120051231D                           
K0077001003FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, EACH                          Front caster assem complete 32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0078001003PNEUMATIC CASTER TIRE TUBE, EACH                                                Pneumatic caster tire tube  32      A                                                                            E2215                    C                          D1D APR    0199401012006010120051231D                           
K0079001003WHEEL LOCK EXTENSION, PAIR                                                      Wheel lock extension pair   32      A                                                                            E0961                    C                          D1D APR    0199401012004010120031231N                           
K0080001003ANTI-ROLLBACK DEVICE, PAIR                                                      Anti-rollback device pair   32      A                                                                            E0974                    C                          D1D APR    0199401012004010120031231N                           
K0081001003WHEEL LOCK ASSEMBLY, COMPLETE, EACH                                             Wheel lock assembly complete32      A                                                                            E2206                    C                          D1D APR    0199401012005010120041231N                           
K008200100322 NF NON-SEALED LEAD ACID BATTERY, EACH                                        22 nf nonsealed leadacid    32      A                                                                            E2360                    C                          D1D APR    0199401012004010120031231N                           
K008300100322 NF SEALED LEAD ACID BATTERY, EACH (E.G., GEL CELL, ABSORBED GLASS MAT)       22nf sealed leadacid battery32      A                                                                            E2361                    C                          D1D APR    0199401012004010120031231N                           
K0084001003GROUP 24 NON-SEALED LEAD ACID BATTERY, EACH                                     Gr24 nonsealed leadacid     32      A                                                                            E2362                    C                          D1D APR    0199401012004010120031231N                           
K0085001003GROUP 24 SEALED LEAD ACID BATTERY, EACH (E.G., GEL CELL, ABSORBED GLASS MAT)    Gr24 sealed leadacid battery32      A                                                                            E2363                    C                          D1D APR    0199401012004010120031231N                           
K0086001003U-1 NON-SEALED LEAD ACID BATTERY, EACH                                          U1nonsealed leadacid battery32      A                                                                            E2364                    C                          D1D APR    0199401012004010120031231N                           
K0087001003U-1 SEALED LEAD ACID BATTERY, EACH (E.G., GEL CELL, ABSORBED GLASS MAT)         U1 sealed leadacid battery  32      A                                                                            E2365                    C                          D1D APR    0199401012004010120031231N                           
K0088001003BATTERY CHARGER, SINGLE MODE, FOR USE WITH ONLY ONE BATTERY TYPE, SEALED OR     Battery charger, single mode32      A                                                                            E2366                    C                          D1D APR    0199401012004010120031231N                           
K0088002004NON-SEALED                                                                                                                                                                                                                                                                                                           
K0089001003BATTERY CHARGER, DUAL MODE, FOR USE WITH EITHER BATTERY TYPE, SEALED OR         Battery charger, dual mode  32      A                                                                            E2367                    C                          D1D APR    0199401012004010120031231N                           
K0089002004NON-SEALED                                                                                                                                                                                                                                                                                                           
K0090001003REAR WHEEL TIRE FOR POWER WHEELCHAIR, ANY SIZE, EACH                            Rear tire power wheelchair  32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0091001003REAR WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR POWER WHEELCHAIR, ANY SIZE,   Rear tire tube power whlchr 32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0091002004EACH                                                                                                                                                                                                                                                                                                                 
K0092001003REAR WHEEL ASSEMBLY FOR POWER WHEELCHAIR, COMPLETE, EACH                        Rear assem cmplt powr whlchr32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0093001003REAR WHEEL, ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER WHEELCHAIR,    Rear zero pressure tire tube32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0093002004ANY SIZE, EACH                                                                                                                                                                                                                                                                                                       
K0094001003WHEEL TIRE FOR POWER BASE, ANY SIZE, EACH                                       Wheel tire for power base   32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0095001003WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR EACH BASE, ANY SIZE, EACH          Wheel tire tube each base   32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0096001003WHEEL ASSEMBLY FOR POWER BASE, COMPLETE, EACH                                   Wheel assem powr base complt32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0097001003WHEEL ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER BASE, ANY SIZE, EACH Wheel zero presure tire tube32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0098001003DRIVE BELT FOR POWER WHEELCHAIR                                                 Drive belt power wheelchair 32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0099001003FRONT CASTER FOR POWER WHEELCHAIR, EACH                                         Pwr wheelchair front  caster32      A                                                                                                     C                          D1D APR    01994010119991001        N                           
K0100001003WHEELCHAIR ADAPTER FOR AMPUTEE, PAIR (DEVICE USED TO COMPENSATE FOR TRANSFER OF Amputee adapter pair        32      A                                                                            E0959                    C                          D1D APR    0199401012004010120031231N                           
K0100002004WEIGHT DUE TO LOST LIMBS TO MAINTAIN PROPER BALANCE)                                                                                                                                                                                                                                                                 
K0101001003ONE-ARM DRIVE ATTACHMENT, EACH                                                  One-arm drive attachment    36      A                                                                            E0958                    C                          D1D R      0199401012003010120021231N                           
K0102001003CRUTCH AND CANE HOLDER, EACH                                                    Crutch and cane holder      32      A                                                                            E2207                    C                          D1D APR    0199401012006010120051231D                           
K0103001003TRANSFER BOARD,<25"                                                             Transfer board < 25        32      A                                                                            E0972                    C                          D1D APR    0199401012004010120031231N                           
K0104001003CYLINDER TANK CARRIER, EACH                                                     Cylinder tank carrier       32      A                                                                            E2208                    C                          D1D APR    0199401012006010120051231D                           
K0105001003IV HANGER, EACH                                                                 Iv hanger                   32      A                                                                                                     C                          D1D APR    01994010120000101        N                           
K0106001003ARM TROUGH, EACH                                                                Arm trough each             32      A                                                                            E2209                    C                          D1D APR    0199401012006010120051231D                           
K0107001003WHEELCHAIR TRAY                                                                 Wheelchair tray             32      A                                                                            E0950                    C                          D1D APR    0199401012004010120031231N                           
K0108001003WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED                      W/c component-accessory NOS 46      A                                                                                                     C                          D1D APR    01994010119990701        N                           
K0112001003TRUNK SUPPORT DEVICE, VEST TYPE, WITH INNER FRAME, PREFABRICATED                Trunk vest supprt innr frame38      A                                                                                                     C                          D1F P      0199401012004010120031231N                           
K0113001003TRUNK SUPPORT DEVICE, VEST TYPE, WITHOUT INNER FRAME, PREFABRICATED             Trunk vest suprt w/o inr frm38      A                                                                                                     C                          D1F P      0199401012004010120031231N                           
K0114001003BACK SUPPORT SYSTEM FOR USE WITH A WHEELCHAIR, WITH INNER FRAME, PREFABRICATED  Whlchr back suprt inr frame 32      A                                                                                                     C                          D1D APR    0199401012005010120041231N                           
K0115001003SEATING SYSTEM, BACK MODULE, POSTERIORLATERAL CONTROL, WITH OR WITHOUT LATERAL  Back module orthotic system 32      A                                                                                                     C                          D1E APR    0199401012005010120041231N                           
K0115002004SUPPORTS, CUSTOM FABRICATED FOR ATTACHMENT TO WHEELCHAIR BASE                                                                                                                                                                                                                                                        
K0116001003SEATING SYSTEM, COMBINED BACK AND SEAT MODULE, CUSTOM FABRICATED FOR ATTACHMENT Back & seat modul orthot sys32      A                                                                                                     C                          D1E APR    0199401012005010120041231N                           
K0116002004TO WHEELCHAIR BASE                                                                                                                                                                                                                                                                                                   
K0183001003NASAL APPLICATION DEVICE USED WITH POSITIVE AIRWAY PRESSURE DEVICE              Nasal application device    32      A                                                                            A7034                    C                          D1E APR    0199401012003010120021231N                           
K0184001003NASAL SINGLE PIECE INTERFACE, REPLACEMENT FOR NASAL APPLICATION DEVICE, PAIR OR Nasal pillow or face seal   32      A                                                                            A7032A7033               C                          D1E APR    0199401012003010120021231N                           
K0184002004SINGLE PIECE INTERFACE                                                                                                                                                                                                                                                                                               
K0185001003HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE                              Pos airway pressure headgear32      A                                                                            A7035                    C                          D1E APR    0199401012003010120021231N                           
K0186001003CHIN STRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE                            Pos airway prssure chinstrap32      A                                                                            A7036                    C                          D1E APR    0199401012003010120021231N                           
K0187001003TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE                                Pos airway pressure tubing  32      A                                                                            A7037                    C                          D1E APR    0199401012003010120021231N                           
K0188001003FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE                   Pos airway pressure filter  32      A                                                                            A7038                    C                          D1E APR    0199401012003010120021231N                           
K0189001003FILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE               Filter nondisposable w PAP  32      A                                                                            A7039                    C                          D1E APR    0199401012003010120021231N                           
K0195001003ELEVATING LEG RESTS, PAIR (FOR USE WITH CAPPED RENTAL WHEELCHAIR BASE)          Elevating whlchair leg rests36      A60-9                                                                                                 D                          D1D R      01993010119930101        N                           
K0268001003HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE               Humidifier nonheated w PAP  32      A                                                                            E0561                    C                          D1E APR    0199301012004010120031231N                           
K0415001003PRESCRIPTION ANTIEMETIC DRUG, ORAL, PER 1 MG, FOR USE IN CONJUNCTION WITH ORAL  RX antiemetic drg, oral NOS 51      A                  2049.5c                                                                            D                          O1D 1      0199601012006010120051231D                           
K0415002004ANTI-CANCER DRUG, NOT OTHERWISE SPECIFIED                                                                                                                                                                                                                                                                            
K0416001003PRESCRIPTION ANTIEMETIC DRUG, RECTAL, PER 1 MG, FOR USE IN CONJUNCTION WITH     Rx antiemetic drg,rectal NOS51      A                  2049.5c                                                                            D                          O1D 1      0199601012006010120051231D                           
K0416002004ORAL ANTI-CANCER DRUG, NOT OTHERWISE SPECIFIED                                                                                                                                                                                                                                                                       
K0452001003WHEELCHAIR BEARINGS, ANY TYPE                                                   Wheelchair bearings         32      A                                                                            E2210                    C                          D1D APR    0199701012006010120051231D                           
K0455001003INFUSION PUMP USED FOR UNINTERRUPTED PARENTERAL ADMINISTRATION OF MEDICATION,   Pump uninterrupted infusion 31      A60-14                                                                                                D                          D1E R      01998010120030701        N                           
K0455002004(E.G., EPOPROSTENOL OR TREPROSTINOL)                                                                                                                                                                                                                                                                                 
K0460001003POWER ADD-ON, TO CONVERT MANUAL WHEELCHAIR TO MOTORIZED WHEELCHAIR, JOYSTICK    WC power add-on joystick    36      A                                                                            E0983                    C                          D1D PR     0199807012004010120031231N                           
K0460002004CONTROL                                                                                                                                                                                                                                                                                                              
K0461001003POWER ADD-ON, TO CONVERT MANUAL WHEELCHAIR TO POWER OPERATED VEHICLE, TILLER    WC power add-on tiller cntrl32      A                                                                            E0984                    C                          D1D PR     0199807012004010120031231N                           
K0461002004CONTROL                                                                                                                                                                                                                                                                                                              
K0462001003TEMPORARY REPLACEMENT FOR PATIENT OWNED EQUIPMENT BEING REPAIRED, ANY TYPE      Temporary replacement eqpmnt32      A                  5102.3                                                                             D                          D1E 9      01998070119980701        N                           
K0531001003HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE                   Heated humidifier used w pap32      A60-9                                                                        E0562                    D                          D1E APR    0199910012004010120031231N                           
K0532001003RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE    Noninvasive assist wo backup36      A60-9                                                                        E0470                    D                          D1E R      0199910012004010120031231N                           
K0532002004FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK                                                                                                                                                                                                                                                 
K0532003004(INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                         
K0533001003RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACKUP RATE       Noninvasive assist w backup 31      A60-9                                                                        E0471                    D                          D1E R      0199910012004010120031231N                           
K0533002004FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK                                                                                                                                                                                                                                                 
K0533003004(INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                         
K0534001003RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPACITY, WITH BACK UP RATE        Invasive assist w backup    31      A60-9                                                                        E0472                    D                          D1E R      0199910012004010120031231N                           
K0534002004FEATURE, USED WITH INVASIVE INTERFACE, E.G., TRACHEOSTOMY TUBE (INTERMITTENT                                                                                                                                                                                                                                         
K0534003004ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)                                                                                                                                                                                                                                                       
K0538001003NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE         Neg pressure wnd thrpy pump 36      A                                                                            E2402                    C                          D1E R      0200010012004010120031231N                           
K0539001003DRESSING SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR Neg pres wnd thrpy dsg set  34      A                                                                            A6550                    C                          D1E P      0200010012004010120031231N                           
K0539002004PORTABLE, EACH                                                                                                                                                                                                                                                                                                       
K0540001003CANISTER SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR Neg pres wnd thrp canister  34      A                                                                            A6551                    C                          D1E P      0200010012004010120031231N                           
K0540002004PORTABLE, EACH                                                                                                                                                                                                                                                                                                       
K0541001003SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES, LESS   SGD prerecorded msg <= 8 min32      A60-23                                                                       E2500                    D                          D1E APR    0200101012004010120031231N                           
K0541002004THAN OR EQUAL TO 8 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                            
K0542001003SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerecorded msg > 8 min 32      A60-23                                                                                                D                          D1E APR    0200101012004010120031231N                           
K0542002004GREATER THAN 8 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                                
K0543001003SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, REQUIRING MESSAGE FORMULATION BY  SGD msg formed by spelling  32      A60-23                                                                       E2508                    D                          D1E APR    0200101012004010120031231N                           
K0543002004SPELLING AND ACCESS BY PHYSICAL CONTACT WITH THE DEVICE                                                                                                                                                                                                                                                              
K0544001003SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, PERMITTING MULTIPLE METHODS OF    SGD w multi methods msg/accs32      A60-23                                                                       E2510                    D                          D1E APR    0200101012004010120031231N                           
K0544002004MESSAGE FORMULATION AND MULTIPLE METHODS OF DEVICE ACCESS                                                                                                                                                                                                                                                            
K0545001003SPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL COMPUTER OR PERSONAL DIGITAL   SGD sftwre prgrm for PC/PDA 32      A60-23                                                                       E2511                    D                          D1E APR    0200101012004010120031231N                           
K0545002004ASSISTANT                                                                                                                                                                                                                                                                                                            
K0546001003ACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING SYSTEM                         SGD accessory,mounting systm32      A60-23                                                                       E2512                    D                          D1E APR    0200101012004010120031231N                           
K0547001003ACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERWISE CLASSIFIED                SGD accessory NOC           46      A60-23                                                                       E2599                    D                          D1E APR    0200101012004010120031231N                           
K0548001003INJECTION, INSULIN LISPRO, UP TO 50 UNITS                                       Insulin lispro              51      A                                                                            J1817                    C                          O1E 1P     0200104012003010120021231N                           
K0549001003HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350     Hosp bed hvy dty xtra wide  36      A60-18                                                                       E0303                    D                          D1B R      0200104012004010120031231N                           
K0549002004POUNDS, BUT LESS THAN OR EQUAL TO 600 POUNDS, WITH ANY TYPE SIDE RAILS, WITH                                                                                                                                                                                                                                         
K0549003004MATTRESS                                                                                                                                                                                                                                                                                                             
K0550001003HOSPITAL BED, EXTRA HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN   Hosp bed xtra hvy dty x wide36      A60-18                                                                       E0304                    D                          D1B R      0200104012004010120031231N                           
K0550002004600 POUNDS, WITH ANY TYPE SIDE RAILS, WITH MATTRESS                                                                                                                                                                                                                                                                  
K0551001003RESIDUAL LIMB SUPPORT SYSTEM, SOLID BASE WITH ADJUSTABLE DROP HOOKS, MOUNTS TO  Residual limb support system32      A60-6                                                                        E1020                    D                          D1D APR    0200107012003010120021231N                           
K0551002004WHEELCHAIR FRAME, EACH                                                                                                                                                                                                                                                                                               
K0552001003SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH Supply/ext inf pump syr type34      A60-14                                                                                                D                          D1E P      02003070120030701        N                           
K0556001003ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM      Socket insert w lock mech   38      A                                                                            L5673                    C                          D1F P      0200210012004010120031231N                           
K0556002004EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR                                                                                                                                                                                                                                          
K0556003004EQUAL, FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                                
K0557001003ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM      Socket insert w/o lock mech 38      A                                                                            L5679                    C                          D1F P      0200210012004010120031231N                           
K0557002004EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR                                                                                                                                                                                                                                          
K0557003004EQUAL, NOT FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                            
K0558001003ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET    Intl custm cong/atyp insert 38      A                                                                            L5681                    C                          D1F P      0200210012004010120031231N                           
K0558002004INSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC                                                                                                                                                                                                                                       
K0558003004OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER                                                                                                                                                                                                                                         
K0558004004THAN INITIAL, USE CODE K0556 OR K0557)                                                                                                                                                                                                                                                                               
K0559001003ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET    Initial custom socket insert38      A                                                                            L5683                    C                          D1F P      0200210012004010120031231N                           
K0559002004INSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL,                                                                                                                                                                                                                                        
K0559003004ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY                                                                                                                                                                                                                                        
K0559004004(FOR OTHER THAN INITIAL, USE CODE K0556 OR K0557)                                                                                                                                                                                                                                                                    
K0560001003METACARPAL PHALANGEAL JOINT REPLACEMENT, TWO PIECES, METAL (E.G., STAINLESS     MCP joint 2-piece for implnt38      A                  2130                                                      L8631                    D                          D1F P      0200304012004010120031231N                           
K0560002004STEEL OR COBALT CHROME), CERAMIC-LIKE MATERIAL (E.G., PYROCARBON), FOR SURGICAL                                                                                                                                                                                                                                      
K0560003004IMPLANTATION (ALL SIZES, INCLUDES ENTIRE SYSTEM)                                                                                                                                                                                                                                                                     
K0561001003OSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE                         Nonpectin based ostomy paste37      A                  2130                                                      A4405                    D                          D1A P      0200204012003010120021231N                           
K0562001003OSTOMY SKIN BARRIER, PECTIN-BASED, PASTE, PER OUNCE                             Pectin based ostomy paste   37      A                  2130                                                      A4406                    D                          D1A P      0200204012003010120021231N                           
K0563001003OSTOMY SKIN BARRIER WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,  Ext wear ost skn barr <=4sq"37      A                  2130                                                      A4407                    D                          D1A P      0200204012003010120021231N                           
K0563002004WITH BUILT-IN CONVEXITY, 4X4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                                 
K0564001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ext wear ost skn barr >4sq" 37      A                  2130                                                      A4408                    D                          D1A P      0200204012003010120021231N                           
K0564002004WITH BUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH                                                                                                                                                                                                                                                                
K0565001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barr w flng <=4sq"  37      A                  2130                                                      A4409                    D                          D1A P      0200204012003010120021231N                           
K0565002004WITHOUT BUILT-IN CONVEXITY, 4X4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                              
K0566001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, Ost skn barr w flng >4sq"   37      A                  2130                                                      A4410                    D                          D1A P      0200204012003010120021231N                           
K0566002004WITHOUT BUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH                                                                                                                                                                                                                                                             
K0567001003OSTOMY POUCH, DRAINABLE, WITH KARAYA BASED BARRIER ATTACHED, WITHOUT BUILT-IN   1 pc drainable ost pouch    37      A                  2130                                                                               D                          D1A P      0200204012003010120021231N                           
K0567002004CONVEXITY, (1 PIECE), EACH                                                                                                                                                                                                                                                                                           
K0568001003OSTOMY POUCH, DRAINABLE, WITH STANDARD WEAR BARRIER ATTACHED, WITHOUT BUILT-IN  1 pc cnvx drainabl ost pouch37      A                  2130                                                                               D                          D1A P      0200204012003010120021231N                           
K0568002004CONVEXITY, (1 PIECE), EACH                                                                                                                                                                                                                                                                                           
K0569001003OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON BARRIER WITH FLANGE (2 PIECE   2 pc drainable ost pouch    37      A                  2130                                                      A4413                    D                          D1A P      0200204012003010120021231N                           
K0569002004SYSTEM), EACH                                                                                                                                                                                                                                                                                                        
K0570001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT        Ostomy skn barr w flng<=4sq"37      A                  2130                                                      A4414                    D                          D1A P      0200204012003010120021231N                           
K0570002004BUILT-IN CONVEXITY, 4X4 INCHES OR SMALLER, EACH                                                                                                                                                                                                                                                                      
K0571001003OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT        Ostomy skn barr w flng >4sq"37      A                  2130                                                      A4415                    D                          D1A P      0200204012003010120021231N                           
K0571002004BUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH                                                                                                                                                                                                                                                                     
K0572001003TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES                                      Non-waterproof tape         37      A                  2130                                                      A4450                    D                          D1A P      0200204012003010120021231N                           
K0573001003TAPE, WATERPROOF, PER 18 SQUARE INCHES                                          Waterproof tape             37      A                  2130                                                      A4452                    D                          D1A P      0200204012003010120021231N                           
K0574001003ADDITION TO OSTOMY POUCH, FILTER, INTEGRAL OR ADDED SEPARATELY TO POUCH, EACH   Ostomy pouch filter         37      A                  2130                                                                               D                          D1A P      0200204012003010120021231N                           
K0575001003ADDITION TO OSTOMY POUCH, RUSTLE-FREE MATERIAL, PER POUCH                       Ost pouch rustle free mat   37      A                  2130                                                                               D                          D1A P      0200204012003010120021231N                           
K0576001003ADDITION TO OSTOMY POUCH, FRICTION AND IRRITANT-REDUCING, ABSORBENT, INTERFACE  Ostomy pouch comfort panel  37      A                  2130                                                                               D                          D1A P      0200204012003010120021231N                           
K0576002004LAYER (COMFORT PANEL), PER POUCH                                                                                                                                                                                                                                                                                     
K0577001003ADDITION TO OSTOMY POUCH, ODOR BARRIER, INCORPORATED INTO POUCH LAMINATE, PER   Ostomy pouch odor barrier   37      A                  2130                                                                               D                          D1A P      0200204012003010120021231N                           
K0577002004POUCH                                                                                                                                                                                                                                                                                                                
K0578001003ADDITION TO OSTOMY POUCH, FAUCET-TYPE TAP WITH VALVE FOR DRAINING URINARY       Urinary pouch faucet/drain  37      A                  2130                                                                               D                          D1A P      0200204012003010120021231N                           
K0578002004POUCH, EACH                                                                                                                                                                                                                                                                                                          
K0579001003ADDITION TO OSTOMY POUCH, ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKET) TO      Ost pouch absorbent material37      A                  2130                                                      A4422                    D                          D1A P      0200204012003010120021231N                           
K0579002004THICKEN LIQUID STOMAL OUTPUT, FOR USE IN POUCH, EACH                                                                                                                                                                                                                                                                 
K0580001003ADDITION TO OSTOMY POUCH, FLANGE LOCKING                                        Ost pouch locking flange    37      A                  2130                                                                               D                          D1A P      0200204012003010120021231N                           
K0581001003OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH        Ost pch clsd w barrier/filtr37      A                                                                            A4416                    C                          D1F P      0200301012004010120031231N                           
K0582001003OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH      Ost pch w bar/bltinconv/fltr37      A                                                                            A4417                    C                          D1F P      0200301012004010120031231N                           
K0582002004FILTER (1 PIECE), EACH                                                                                                                                                                                                                                                                                               
K0583001003OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH     Ost pch clsd w/o bar w filtr37      A                                                                            A4418                    C                          D1F P      0200301012004010120031231N                           
K0584001003OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH FLANGE, WITH FILTER (2 PIECE),    Ost pch for bar w flange/flt37      A                                                                            A4419                    C                          D1F P      0200301012004010120031231N                           
K0584002004EACH                                                                                                                                                                                                                                                                                                                 
K0585001003OSTOMY 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      0200301012004010120031231N                           
K0586001003OSTOMY 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      0200301012004010120031231N                           
K0586002004PIECE), EACH                                                                                                                                                                                                                                                                                                         
K0587001003OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH     Ost pch drain w bar & filter37      A                                                                            A4424                    C                          D1F P      0200301012004010120031231N                           
K0588001003OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH FLANGE, WITH FILTER (2 PIECE   Ost pch drain for barrier fl37      A                                                                            A4425                    C                          D1F P      0200301012004010120031231N                           
K0588002004SYSTEM), EACH                                                                                                                                                                                                                                                                                                        
K0589001003OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE        Ost pch drain 2 piece system37      A                                                                            A4426                    C                          D1F P      0200301012004010120031231N                           
K0589002004SYSTEM), EACH                                                                                                                                                                                                                                                                                                        
K0590001003OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2 Ost pch drain/barr lk flng/f37      A                                                                            A4427                    C                          D1F P      0200301012004010120031231N                           
K0590002004PIECE SYSTEM), EACH                                                                                                                                                                                                                                                                                                  
K0591001003OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FAUCET-TYPE    Urine ost pouch w faucet/tap37      A                                                                            A4428                    C                          D1F P      0200301012004010120031231N                           
K0591002004TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                                                       
K0592001003OSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH     Urine ost pouch w bltinconv 37      A                                                                            A4429                    C                          D1F P      0200301012004010120031231N                           
K0592002004FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                                           
K0593001003OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN       Ost urine pch w b/bltin conv37      A                                                                            A4430                    C                          D1F P      0200301012004010120031231N                           
K0593002004CONVEXITY, WITH FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH                                                                                                                                                                                                                                                           
K0594001003OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH VALVE   Ost pch urine w barrier/tapv37      A                                                                            A4431                    C                          D1F P      0200301012004010120031231N                           
K0594002004(1 PIECE), EACH                                                                                                                                                                                                                                                                                                      
K0595001003OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH FLANGE, WITH FAUCET-TYPE TAP     Os pch urine w bar/fange/tap37      A                                                                            A4432                    C                          D1F P      0200301012004010120031231N                           
K0595002004WITH VALVE (2 PIECE), EACH                                                                                                                                                                                                                                                                                           
K0596001003OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH   Urine ost pch bar w lock fln37      A                                                                            A4433                    C                          D1F P      0200301012004010120031231N                           
K0597001003OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FAUCET-TYPE Ost pch urine w lock flng/ft37      A                                                                            A4434                    C                          D1F P      0200301012004010120031231N                           
K0597002004TAP WITH VALVE (2 PIECE), EACH                                                                                                                                                                                                                                                                                       
K0600001003FUNCTIONAL NEUROMUSCULAR STIMULATOR, TRANSCUTANEOUS STIMULATION OF MUSCLES OF   Functional neuromuscularstim32      A35-77                                                                       E0762                    D                          D1E APR    0200304012006010120051231D                           
K0600002004AMBULATION WITH COMPUTER CONTROL, USED FOR WALKING BY SPINAL CORD INJURED,                                                                                                                                                                                                                                           
K0600003004ENTIRE SYSTEM, AFTER COMPLETION OF TRAINING PROGRAM                                                                                                                                                                                                                                                                  
K0601001003REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE,  Repl batt silver oxide 1.5 v32      A                                                                                                     C                          D1E APR    02003040120030401        N                           
K06010020041.5 VOLT, EACH                                                                                                                                                                                                                                                                                                       
K0602001003REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE,  Repl batt silver oxide 3 v  32      A                                                                                                     C                          D1E APR    02003040120030401        N                           
K06020020043 VOLT, EACH                                                                                                                                                                                                                                                                                                         
K0603001003REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, ALKALINE, 1.5  Repl batt alkaline 1.5 v    32      A                                                                                                     C                          D1E APR    02003040120030401        N                           
K0603002004VOLT, EACH                                                                                                                                                                                                                                                                                                           
K0604001003REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 3.6   Repl batt lithium 3.6 v     32      A                                                                                                     C                          D1E APR    02003040120030401        N                           
K0604002004VOLT, EACH                                                                                                                                                                                                                                                                                                           
K0605001003REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 4.5   Repl batt lithium 4.5 v     32      A                                                                                                     C                          D1E APR    02003040120030401        N                           
K0605002004VOLT, EACH                                                                                                                                                                                                                                                                                                           
K0606001003AUTOMATIC EXTERNAL DEFIBRILLATOR, WITH INTEGRATED ELECTROCARDIOGRAM ANALYSIS,   AED garment w elec analysis 36      A                                                                                                     C                          D1E APR    02003070120030701        N                           
K0606002004GARMENT TYPE                                                                                                                                                                                                                                                                                                         
K0607001003REPLACEMENT BATTERY FOR AUTOMATED EXTERNAL DEFIBRILLATOR, GARMENT TYPE ONLY,    Repl batt for AED           32      A                                                                                                     C                          D1E APR    02003070120030701        N                           
K0607002004EACH                                                                                                                                                                                                                                                                                                                 
K0608001003REPLACEMENT GARMENT FOR USE WITH AUTOMATED EXTERNAL DEFIBRILLATOR, EACH         Repl garment for AED        32      A                                                                                                     C                          D1E APR    02003070120030701        N                           
K0609001003REPLACEMENT ELECTRODES FOR USE WITH AUTOMATED EXTERNAL DEFIBRILLATOR, GARMENT   Repl electrode for AED      34      A                                                                                                     C                          D1E P      02003070120030701        N                           
K0609002004TYPE ONLY, EACH                                                                                                                                                                                                                                                                                                      
K0610001003PERITONEAL DIALYSIS CLAMPS, EACH                                                Peritoneal dialysis clamp   52      A                  4270                                                      E1634                    D                          P9B L      0200307012004010120031231N                           
K0611001003DISPOSABLE CYCLER SET USED WITH CYCLER DIALYSIS MACHINE, EACH                   Disposable cycler set       52      A                  4270                                                      A4671                    D                          P9B L      0200307012004010120031231N                           
K0612001003DRAINAGE EXTENSION LINE, STERILE, FOR DIALYSIS, EACH                            Drainage ext line, dialysis 52      A                  4270                                                      A4672                    D                          P9B L      0200307012004010120031231N                           
K0613001003EXTENSION LINE WITH EASY LOCK CONNECTORS, USED WITH DIALYSIS                    Ext line w easy lock connect52      A                  4270                                                      A4673                    D                          P9B L      0200307012004010120031231N                           
K0614001003CHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERILIZE DIALYSIS EQUIPMENT, PER  Chem/antisept solution, 8oz 52      A                  4270                                                      A4674                    D                          P9B L      0200307012004010120031231N                           
K06140020048 OZ                                                                                                                                                                                                                                                                                                                 
K0615001003SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec mes >8min <=20min32      A60-23                                                                       E2502                    D                          D1E APR    0200307012004010120031231N                           
K0615002004GREATER THAN 8 MINUTES BUT LESS THAN OR EQUAL TO 20 MINUTES RECORDING TIME                                                                                                                                                                                                                                           
K0616001003SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec mes>20min <=40min32      A60-23                                                                       E2504                    D                          D1E APR    0200307012004010120031231N                           
K0616002004GREATER THAN 20 MINUTES BUT LESS THAN OR EQUAL TO 40 MINUTES RECORDING TIME                                                                                                                                                                                                                                          
K0617001003SPEECH GENERATING DEVICE, DIGITIZED SPEECH, USING PRE-RECORDED MESSAGES,        SGD prerec mes > 40min      32      A60-23                                                                       E2506                    D                          D1E APR    0200307012004010120031231N                           
K0617002004GREATER THAN 40 MINUTES RECORDING TIME                                                                                                                                                                                                                                                                               
K0618001003TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID      TLSO 2 piece rigid shell    38      A                                                                            L0491                    C                          D1F P      0200307012006010120051231D                           
K0618002004PLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                               
K0618003004TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE                                                                                                                                                                                                                                            
K0618004004SYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE                                                                                                                                                                                                                                      
K0618005004SAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                             
K0618006004PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
K0618007004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K0619001003TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID    TLSO 3 piece rigid shell    38      A                                                                            L0492                    C                          D1F P      0200307012006010120051231D                           
K0619002004PLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                               
K0619003004TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE                                                                                                                                                                                                                                            
K0619004004SYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE                                                                                                                                                                                                                                      
K0619005004SAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                             
K0619006004PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
K0619007004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K0620001003TUBULAR ELASTIC DRESSING, ANY WIDTH, PER LINEAR YARD                            Tubular elastic dressing    35      A                                                                            A6457                    C                          D1A S      0200307012006010120051231D                           
K0621001003GAUZE, PACKING STRIPS, NON-IMPREGNATED, UP TO 2 INCHES IN WIDTH, PER LINEAR YARDGauze, non-impreg pack strip35      A                                                                                                     C                          D1A S      0200307012004010120031231N                           
K0622001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE WIDTH LESS THAN     Confrm band non str <3in/rol35      A                                                                                                     C                          D1A S      0200310012004010120031231N                           
K0622002004THREE INCHES, PER ROLL                                                                                                                                                                                                                                                                                               
K0623001003CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE WIDTH LESS THAN THREE   Confrm band sterl>3in/roll  35      A                                                                                                     C                          D1A S      0200310012004010120031231N                           
K0623002004INCHES, PER ROLL                                                                                                                                                                                                                                                                                                     
K0624001003LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH LESS THAN 3 INCHES,    Lite compress wdth<3in/roll 35      A                                                                                                     C                          D1A S      0200310012004010120031231N                           
K0624002004PER ROLL (AT LEAST 3 YARDS UNSTRETCHED)                                                                                                                                                                                                                                                                              
K0625001003SELF ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, LOAD RESISTANCE GREATER  Self adher wdth <3 in, roll 35      A                                                                                                     C                          D1A S      0200310012004010120031231N                           
K0625002004THAN OR EQUAL TO 0.55 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH LESS THAN 3                                                                                                                                                                                                                                          
K0625003004INCHES, PER ROLL                                                                                                                                                                                                                                                                                                     
K0626001003SELF ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, LOAD RESISTANCE GREATER  Self adher wdth >=5 in, roll35      A                                                                                                     C                          D1A S      0200310012004010120031231N                           
K0626002004THAN OR EQUAL TO 0.55 FOOT POUNDS AT 50% MAXIMUM STRETCH, WIDTH GREATER THAN OR                                                                                                                                                                                                                                      
K0626003004EQUAL TO 5 INCHES, PER ROLL                                                                                                                                                                                                                                                                                          
K0627001003TRACTION EQUIPMENT, CERVICAL, FREE-STANDING, PNEUMATIC, APPLYING TRACTION FORCE Cervical pneum trac equip   32      A                                                                            E0849                    C                          D1E APR    0200404012005010120041231N                           
K0627002004TO OTHER THAN MANDIBLE                                                                                                                                                                                                                                                                                               
K0628001003FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT      Multi den insert direct form52      A                                                                            A5512                    C                          D1F J      0200404012006010120051231D                           
K0628002004AFTER EXTERNAL HEAT SOURCE OF 230 DEGREES FAHRENHEIT OR HIGHER, TOTAL CONTACT                                                                                                                                                                                                                                        
K0628003004WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER MINIMUM OF 1/4 INCH MATERIAL OF                                                                                                                                                                                                                                      
K0628004004SHORE A 35 DUROMETER OR 3/16 INCH MATERIAL OF SHORE A 40 DUROMETER (OR HIGHER),                                                                                                                                                                                                                                      
K0628005004PREFABRICATED, EACH                                                                                                                                                                                                                                                                                                  
K0629001003FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, CUSTOM MOLDED FROM MODEL OF        Multi den insert custom mold52      A                                                                            A5513                    C                          D1F J      0200404012006010120051231D                           
K0629002004PATIENT'S FOOT, TOTAL CONTACT WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER                                                                                                                                                                                                                                        
K0629003004MINIMUM OF 3/16 INCH MATERIAL OF SHORE A 35 DUROMETER OR HIGHER, INCLUDES ARCH                                                                                                                                                                                                                                       
K0629004004FILLER AND OTHER SHAPING MATERIAL, CUSTOM FABRICATED, EACH                                                                                                                                                                                                                                                           
K0630001003SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION   SIO flex pelvisacral prefab 38      A                                                                            L0621                    C                          D1F P      0200404012006010120051231D                           
K0630002004ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS                                                                                                                                                                                                                                         
K0630003004ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
K0631001003SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION   SIO flex pelvisacral custom 38      A                                                                            L0622                    C                          D1F P      0200404012006010120051231D                           
K0631002004ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS                                                                                                                                                                                                                                         
K0631003004ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                    
K0632001003SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID   SIO panel prefab            38      A                                                                            L0623                    C                          D1F P      0200404012006010120051231D                           
K0632002004PANELS OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT,                                                                                                                                                                                                                                       
K0632003004INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                      
K0632004004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K0633001003SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID   SIO panel custom            38      A                                                                            L0624                    C                          D1F P      0200404012006010120051231D                           
K0633002004PANELS PLACED OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC                                                                                                                                                                                                                                       
K0633003004JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM                                                                                                                                                                                                                                       
K0633004004FABRICATED                                                                                                                                                                                                                                                                                                           
K0634001003LUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT, POSTERIOR EXTENDS FROM L1   LO flexibl L1-below L5 pre  38      A                                                                            L0625                    C                          D1F P      0200404012006010120051231D                           
K0634002004TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE                                                                                                                                                                                                                                         
K0634003004INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN                                                                                                                                                                                                                                       
K0634004004DESIGN, SHOULDER STRAPS, STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                       
K0635001003LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR     LO sag stays/panels pre-fab 38      A                                                                            L0626                    C                          D1F P      0200404012006010120051231D                           
K0635002004EXTENDS FROM L1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                            
K0635003004REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE                                                                                                                                                                                                                                      
K0635004004PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                            
K0635005004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K0636001003LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS,    LO sagitt rigid panel prefab38      A                                                                            L0627                    C                          D1F P      0200404012006010120051231D                           
K0636002004POSTERIOR EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                             
K0636003004PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K0636004004MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                       
K0636005004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K0637001003LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR      LO flex w/o rigid stays pre 38      A                                                                            L0628                    C                          D1F P      0200404012006010120051231D                           
K0637002004EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                         
K0637003004PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K0637004004MAY INCLUDE STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                         
K0637005004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K0638001003LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR      LSO flex w/rigid stays cust 38      A                                                                            L0629                    C                          D1F P      0200404012006010120051231D                           
K0638002004EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                         
K0638003004PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K0638004004MAY INCLUDE STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                      
K0639001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S),        LSO post rigid panel pre    38      A                                                                            L0630                    C                          D1F P      0200404012006010120051231D                           
K0639002004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES                                                                                                                                                                                                                                             
K0639003004INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES                                                                                                                                                                                                                                          
K0639004004STRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS                                                                                                                                                                                                                                             
K0639005004ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
K0640001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR     LSO sag-coro rigid frame pre38      A                                                                            L0631                    C                          D1F P      0200404012006010120051231D                           
K0640002004PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                              
K0640003004PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,                                                                                                                                                                                                                                          
K0640004004INCLUDES STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                       
K0640005004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
K0641001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR     LSO sag-cor rigid frame cust38      A                                                                            L0632                    C                          D1F P      0200404012006010120051231D                           
K0641002004PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                              
K0641003004PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,                                                                                                                                                                                                                                          
K0641004004INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS                                                                                                                                                                                                                                           
K0641005004ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                    
K0642001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR          LSO flexion control prefab  38      A                                                                            L0633                    C                          D1F P      0200404012006010120051231D                           
K0642002004FRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                      
K0642003004LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                      
K0642004004PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
K0642005004INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                                   
K0642006004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
K0643001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR          LSO flexion control custom  38      A                                                                            L0634                    C                          D1F P      0200404012006010120051231D                           
K0643002004FRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                      
K0643003004LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                      
K0643004004PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
K0643005004INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, CUSTOM                                                                                                                                                                                                                                            
K0643006004FABRICATED                                                                                                                                                                                                                                                                                                           
K0644001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID         LSO sagit rigid panel prefab38      A                                                                            L0635                    C                          D1F P      0200404012006010120051231D                           
K0644002004POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE,                                                                                                                                                                                                                                        
K0644003004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL                                                                                                                                                                                                                                              
K0644004004STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                              
K0644005004PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
K0644006004INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                            
K0644007004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
K0645001003LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID         LSO sagittal rigid panel cus38      A                                                                            L0636                    C                          D1F P      0200404012006010120051231D                           
K0645002004POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE,                                                                                                                                                                                                                                        
K0645003004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL                                                                                                                                                                                                                                              
K0645004004STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                              
K0645005004PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
K0645006004INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                         
K0646001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND       LSO sag-coronal panel prefab38      A                                                                            L0637                    C                          D1F P      0200404012006010120051231D                           
K0646002004POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9                                                                                                                                                                                                                                        
K0646003004VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES                                                                                                                                                                                                                                          
K0646004004INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
K0646005004CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                            
K0646006004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
K0647001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND       LSO sag-coronal panel custom38      A                                                                            L0638                    C                          D1F P      0200404012006010120051231D                           
K0647002004POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9                                                                                                                                                                                                                                        
K0647003004VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES                                                                                                                                                                                                                                          
K0647004004INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
K0647005004CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                            
K0647006004CUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
K0648001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S)       LSO s/c shell/panel prefab  38      A                                                                            L0639                    C                          D1F P      0200404012006010120051231D                           
K0648002004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                             
K0648003004EXTENDS FROM SYMPHYSIS PUBIS TO XYPHOID, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                          
K0648004004REDUCE LOAD ON THE INTERVERTEBRAL DISCS, OVERALL STRENGTH IS PROVIDED BY                                                                                                                                                                                                                                             
K0648005004OVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K0648006004MAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                        
K0648007004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
K0649001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S),      LSO s/c shell/panel custom  38      A                                                                            L0640                    C                          D1F P      0200404012006010120051231D                           
K0649002004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                             
K0649003004EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                          
K0649004004REDUCE LOAD ON THE INTERVERTEBRAL DISCS, OVERALL STRENGTH IS PROVIDED BY                                                                                                                                                                                                                                             
K0649005004OVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
K0649006004MAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                              
K0650001003GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH       Gen w/c cushion width < 22 32      A                                                                            E2601                    C                          D1D APR    0200407012005010120041231N                           
K0651001003GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH      Gen w/c cushion width > 22 32      A                                                                            E2602                    C                          D1D APR    0200407012005010120041231N                           
K0652001003SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH   Skin pro w/c cus wd < 22   32      A                                                                            E2603                    C                          D1D APR    0200407012005010120041231N                           
K0653001003SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH  Skin protect w/c cus wd>=2232      A                                                                            E2604                    C                          D1D APR    0200407012005010120041231N                           
K0654001003POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH       Position w/c cush width <2232      A                                                                            E2605                    C                          D1D APR    0200407012005010120041231N                           
K0655001003POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH      Position w/c cush width >2232      A                                                                            E2606                    C                          D1D APR    0200407012005010120041231N                           
K0656001003SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22     Skin pro/pos w/c cus wd <2232      A                                                                            E2607                    C                          D1D APR    0200407012005010120041231N                           
K0656002004INCHES, ANY DEPTH                                                                                                                                                                                                                                                                                                    
K0657001003SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR     Skin pro/pos w/c cus wd>=2232      A                                                                            E2608                    C                          D1D APR    0200407012005010120041231N                           
K0657002004GREATER, ANY DEPTH                                                                                                                                                                                                                                                                                                   
K0658001003CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE                             Custom fabricate w/c cushion32      A                                                                            E2609                    C                          D1D APR    0200407012005010120041231N                           
K0659001003WHEELCHAIR SEAT CUSHION, POWERED                                                Powered w/c cushion         32      A                                                                            E2610                    C                          D1D APR    0200407012005010120041231N                           
K0660001003GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS THAN 22 INCHES, ANY HEIGHT,     Gen use back cush width <2232      A                                                                            E2611                    C                          D1D APR    0200407012005010120041231N                           
K0660002004INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                 
K0661001003GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCHES OR GREATER, ANY HEIGHT,    Gen use back cush width >2232      A                                                                            E2612                    C                          D1D APR    0200407012005010120041231N                           
K0661002004INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                                 
K0662001003POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH LESS THAN 22 INCHES, ANY  Position back cush wdth <2232      A                                                                            E2613                    C                          D1D APR    0200407012005010120041231N                           
K0662002004HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                         
K0663001003POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH 22 INCHES OR GREATER, ANY Position back cush wdth >2232      A                                                                            E2614                    C                          D1D APR    0200407012005010120041231N                           
K0663002004HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                                         
K0664001003POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH LESS THAN 22      Pos back post/lat width <2232      A                                                                            E2615                    C                          D1D APR    0200407012005010120041231N                           
K0664002004INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                             
K0665001003POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH 22 INCHES OR      Pos back post/lat width >2232      A                                                                            E2616                    C                          D1D APR    0200407012005010120041231N                           
K0665002004GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE                                                                                                                                                                                                                                                            
K0666001003CUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE         Custom fab w/c back cushion 32      A                                                                            E2617                    C                          D1D APR    0200407012005010120041231N                           
K0666002004MOUNTING HARDWARE                                                                                                                                                                                                                                                                                                    
K0667001003MOUNTING HARDWARE, ANY TYPE, FOR SEAT CUSHION OR SEAT SUPPORT BASE ATTACHED TO  Mt hardwre man/light pwr w/c32      A                                                                                                     C                          D1D APR    0200407012005010120041231N                           
K0667002004A MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, PER CUSHION/BASE                                                                                                                                                                                                                                                
K0668001003REPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR BACK CUSHION, EACH             Replace cover w/c seat cush 32      A                                                                            E2619                    C                          D1D APR    0200407012005010120041231N                           
K0669001003WHEELCHAIR ACCESSORY, WHEELCHAIR SEAT OR BACK CUSHION, DOES NOT MEET SPECIFIC   Seat/back cus no sadmerc ver32      A                                                                                                     C                          D1D APR    02004070120060101        C                           
K0669002004CODE CRITERIA OR NO WRITTEN CODING VERIFICATION FROM SADMERC                                                                                                                                                                                                                                                         
K0670001003ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM,          Stance phase only           38      A                                                                            E1392                    C                          D1F P      0200504012006010120051231D                           
K0670002004MICROPROCESSOR CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC                                                                                                                                                                                                                                               
K0670003004SENSOR(S), ANY TYPE                                                                                                                                                                                                                                                                                                  
K0671001003PORTABLE OXYGEN CONCENTRATOR, RENTAL                                            Portable oxygen concentrator33      A60-4                                                                        E1392                    D                          D1C R      0200504012006010120051231D                           
K0730001003CONTROLLED DOSE INHALATION DRUG DELIVERY SYSTEM                                 Ctrl dose inh drug deliv sys36      A                                                                                                     C                          D1E R      02005070120050701        A                           
K0731001003LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR,      Lith ion bat CID non-ear lvl38      A                                                                            L8623                    C                          D1F P      0200507012006010120051231D                           
K0731002004OTHER THAN EAR LEVEL, REPLACEMENT, EACH                                                                                                                                                                                                                                                                              
K0732001003LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, EAR  Lith ion batt CID ear level 38      A                                                                            L8624                    C                          D1F P      0200507012006010120051231D                           
K0732002004LEVEL, REPLACEMENT, EACH                                                                                                                                                                                                                                                                                             
L0100001003CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT INTERFACE,  MOLDED TO PATIENT   Cranial orthosis/helmet mold38      A                                                                                                     C                          D1F P      01982010120020101        N                           
L0100002004MODEL                                                                                                                                                                                                                                                                                                                
L0110001003CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT-INTERFACE, NON-MOLDED           Cranial orthosis/helmet nonm38      A                                                                                                     C                          D1F P      01982010120020101        N                           
L0112001003CRANIAL CERVICAL ORTHOSIS, CONGENITAL TORTICOLLIS TYPE, WITH OR WITHOUT SOFT    Cranial cervical orthosis   38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L0112002004INTERFACE MATERIAL, ADJUSTABLE RANGE OF MOTION JOINT, CUSTOM FABRICATED                                                                                                                                                                                                                                              
L0120001003CERVICAL, FLEXIBLE, NON-ADJUSTABLE (FOAM COLLAR)                                Cerv flexible non-adjustable38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0130001003CERVICAL, FLEXIBLE, THERMOPLASTIC COLLAR, MOLDED TO PATIENT                     Flex thermoplastic collar mo38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L0140001003CERVICAL, SEMI-RIGID, ADJUSTABLE (PLASTIC COLLAR)                               Cervical semi-rigid adjustab38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0150001003CERVICAL, SEMI-RIGID, ADJUSTABLE MOLDED CHIN CUP (PLASTIC COLLAR WITH           Cerv semi-rig adj molded chn38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0150002004MANDIBULAR/OCCIPITAL PIECE)                                                                                                                                                                                                                                                                                          
L0160001003CERVICAL, SEMI-RIGID, WIRE FRAME OCCIPITAL/MANDIBULAR SUPPORT                   Cerv semi-rig wire occ/mand 38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0170001003CERVICAL, COLLAR, MOLDED TO PATIENT MODEL                                       Cervical collar molded to pt38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L0172001003CERVICAL, COLLAR, SEMI-RIGID THERMOPLASTIC FOAM, TWO PIECE                      Cerv col thermplas foam 2 pi38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L0174001003CERVICAL, COLLAR, SEMI-RIGID, THERMOPLASTIC FOAM, TWO PIECE WITH THORACIC       Cerv col foam 2 piece w thor38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L0174002004EXTENSION                                                                                                                                                                                                                                                                                                            
L0180001003CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE       Cer post col occ/man sup adj38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L0190001003CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE       Cerv collar supp adj cerv ba38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0190002004CERVICAL BARS (SOMI, GUILFORD, TAYLOR TYPES)                                                                                                                                                                                                                                                                         
L0200001003CERVICAL, MULTIPLE POST COLLAR, OCCIPITAL/MANDIBULAR SUPPORTS, ADJUSTABLE       Cerv col supp adj bar & thor38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L0200002004CERVICAL BARS, AND THORACIC EXTENSION                                                                                                                                                                                                                                                                                
L0210001003THORACIC, RIB BELT                                                              Thoracic rib belt           38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0220001003THORACIC, RIB BELT, CUSTOM FABRICATED                                           Thor rib belt custom fabrica38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0300001003THORACIC-LUMBAR-SACRAL-ORTHOSIS (TLSO), FLEXIBLE (DORSO-LUMBAR SURGICAL SUPPORT)TLSO flex surgical support  38      A                                                                                                     C                          D1F P      0198601012003010120021231N                           
L0310001003TLSO, FLEXIBLE, (DORSO-LUMBAR SURGICAL SUPPORT), CUSTOM FABRICATED              Tlso flexible custom fabrica38      A                                                                                                     C                          D1F P      0198201012003010120021231N                           
L0315001003TLSO, FLEXIBLE DORSO-LUMBAR SURGICAL SUPPORT, ELASTIC TYPE, WITH RIGID          Tlso flex elas rigid post pa38      A                                                                                                     C                          D1F P      0198901012003010120021231N                           
L0315002004POSTERIOR PANEL                                                                                                                                                                                                                                                                                                      
L0317001003TLSO, FLEXIBLE DORSO-LUMBAR SURGICAL SUPPORT, HYPEREXTENSION, ELASTIC TYPE,     Tlso flex hypext elas post p38      A                                                                                                     C                          D1F P      0198901012003010120021231N                           
L0317002004WITH RIGID POSTERIOR PANEL                                                                                                                                                                                                                                                                                           
L0320001003TLSO, ANTERIOR-POSTERIOR CONTROL (TAYLOR TYPE), WITH APRON FRONT                Tlso a-p contrl w apron frnt38      A                                                                                                     C                          D1F P      0198601012003010120021231N                           
L0321001003TLSO, ANTERIOR-POSTERIOR CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL,     Tlso anti-post-cntrl prefab 38      A                                                                                                     C                          D1F P      0200201012003010120021231N                           
L0321002004PREFABRICATED (INCLUDES FITTING AND ADJUSTMENT)                                                                                                                                                                                                                                                                      
L0330001003TLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL (KNIGHT-TAYLOR TYPE), WITH APRON FRONT Tlso ant-pos-lateral control38      A                                                                                                     C                          D1F P      0198201012003010120021231N                           
L0331001003TLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR    Tlso ant-post-lat cntrl prfb38      A                                                                                                     C                          D1F P      0200201012003010120021231N                           
L0331002004PANEL, PREFABRICATED (INCLUDES FITTING AND ADJUSTMENT)                                                                                                                                                                                                                                                               
L0340001003TLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL (ARNOLD, MAGNUSON, STEINDLER    Tlso a-p-l-rotary with apron38      A                                                                                                     C                          D1F P      0198401012003010120021231N                           
L0340002004TYPES), WITH APRON FRONT                                                                                                                                                                                                                                                                                             
L0350001003TLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, FLEXION COMPRESSION JACKET,    Tlso flex compress jacket cu38      A                                                                                                     C                          D1F P      0198501012003010120021231N                           
L0350002004CUSTOM FITTED                                                                                                                                                                                                                                                                                                        
L0360001003TLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, FLEXION COMPRESSION JACKET     Tlso flex compress jacket mo38      A                                                                                                     C                          D1F P      0198501012003010120021231N                           
L0360002004MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                              
L0370001003TLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, HYPEREXTENSION (JEWETT,        Tlso a-p-l-rotary hyperexten38      A                                                                                                     C                          D1F P      0198501012003010120021231N                           
L0370002004LENNOX, BAKER, CASH TYPES)                                                                                                                                                                                                                                                                                           
L0380001003TLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, WITH EXTENSIONS                Tlso a-p-l-rot w/ pos extens38      A                                                                                                     C                          D1F P      0198601012003010120021231N                           
L0390001003TLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL MOLDED TO PATIENT MODEL                Tlso a-p-l control molded   38      A                                                                                                     C                          D1F P      0198401012003010120021231N                           
L0391001003TLSO, ANTERIOR-POSTERIOR-LATERAL-ROTARY CONTROL, WITH RIGID OR SEMI-RIGID       Tlso ant-post-lat-rot cntrl 38      A                                                                                                     C                          D1F P      0200201012003010120021231N                           
L0391002004POSTERIOR PANEL, PREFABRICATED (INCLUDES FITTING AND ADJUSTMENT)                                                                                                                                                                                                                                                     
L0400001003TLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL MOLDED TO PATIENT MODEL, WITH          Tlso a-p-l w interface mater38      A                                                                                                     C                          D1F P      0198601012003010120021231N                           
L0400002004INTERFACE MATERIAL                                                                                                                                                                                                                                                                                                   
L0410001003TLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, TWO-PIECE CONSTRUCTION              , Tlso a-p-l two piece constr 38      A                                                                                                     C                          D1F P      0198801012003010120021231N                           
L0410002004MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                              
L0420001003TLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, TWO PIECE CONSTRUCTION              , Tlso a-p-l 2 piece w interfa38      A                                                                                                     C                          D1F P      0198801012003010120021231N                           
L0420002004MOLDED TO PATIENT MODEL, WITH INTERFACE MATERIAL                                                                                                                                                                                                                                                                     
L0430001003SPINAL ORTHOSIS, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH INTERFACE MATERIAL,   Dewall posture protector    38      A                                                                                                     C                          D1F P      01988010120050101        N                           
L0430002004CUSTOM FITTED (DEWALL POSTURE PROTECTOR ONLY)                                                                                                                                                                                                                                                                        
L0440001003TLSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH OVERLAPPING FRONT SECTION,       Tlso a-p-l overlap frnt cust38      A                                                                                                     C                          D1F P      0198801012003010120021231N                           
L0440002004SPRING STEEL FRONT, CUSTOM FITTED                                                                                                                                                                                                                                                                                    
L0450001003TLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, UPPER THORACIC REGION, PRODUCES         TLSO flex prefab thoracic   38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0450002004INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTEVERTEBRAL DISKS WITH RIGID                                                                                                                                                                                                                                          
L0450003004STAYS OR PANEL(S), INCLUDES SHOULDER STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                             
L0450004004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0452001003TLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, UPPER THORACIC REGION, PRODUCES         tlso flex custom fab thoraci38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0452002004INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS WITH RIGID                                                                                                                                                                                                                                         
L0452003004STAYS OR PANEL(S), INCLUDES SHOULDER STRAPS AND CLOSURES, CUSTOM FABRICATED                                                                                                                                                                                                                                          
L0454001003TLSO FLEXIBLE, PROVIDES TRUNK SUPPORT, EXTENDS FROM SACROCOCCYGEAL JUNCTION TO  TLSO flex prefab sacrococ-T938      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0454002004ABOVE T-9 VERTEBRA, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL PLANE,                                                                                                                                                                                                                                              
L0454003004PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS WITH                                                                                                                                                                                                                                      
L0454004004RIGID STAYS OR PANEL(S), INCLUDES SHOULDER STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L0454005004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0456001003TLSO, FLEXIBLE, PROVIDES TRUNK SUPPORT, THORACIC REGION, RIGID POSTERIOR PANEL  TLSO flex prefab            38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0456002004AND SOFT ANTERIOR APRON, EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                                
L0456003004TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, RESTRICTS GROSS TRUNK MOTION IN                                                                                                                                                                                                                                      
L0456004004THE SAGITTAL PLANE, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE                                                                                                                                                                                                                                            
L0456005004INTERVERTEBRAL DISKS, INCLUDES STRAPS AND CLOSURES, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                          
L0456006004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L0458001003TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC     TLSO 2Mod symphis-xipho pre 38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0458002004SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST                                                                                                                                                                                                                                       
L0458003004INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO                                                                                                                                                                                                                                         
L0458004004THE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL,                                                                                                                                                                                                                                      
L0458005004AND TRANVERSE PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING PLASTIC AND                                                                                                                                                                                                                                        
L0458006004STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                          
L0458007004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L0460001003TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC     TLSO2Mod symphysis-stern pre38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0460002004SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST                                                                                                                                                                                                                                       
L0460003004INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO                                                                                                                                                                                                                                         
L0460004004THE STERNAL NOTCH, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL,                                                                                                                                                                                                                                         
L0460005004CORONAL, AND TRANVERSE PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                           
L0460006004PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L0460007004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0462001003TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID PLASTIC   TLSO 3Mod sacro-scap pre    38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0462002004SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST                                                                                                                                                                                                                                       
L0462003004INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO                                                                                                                                                                                                                                         
L0462004004THE STERNAL NOTCH, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL,                                                                                                                                                                                                                                         
L0462005004CORONAL, AND TRANSVERSE PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                          
L0462006004PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L0462007004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0464001003TLSO, TRIPLANAR CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, FOUR RIGID PLASTIC    TLSO 4Mod sacro-scap pre    38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0464002004SHELLS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES JUST                                                                                                                                                                                                                                           
L0464003004INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO THE                                                                                                                                                                                                                                             
L0464004004STERNAL NOTCH, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, CORONAL,                                                                                                                                                                                                                                        
L0464005004AND TRANVERSE PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING PLASTIC AND                                                                                                                                                                                                                                        
L0464006004STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                          
L0464007004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L0466001003TLSO, SAGITTAL CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT ANTERIOR APRON  TLSO rigid frame pre soft ap38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0466002004WITH STRAPS, CLOSURES AND PADDING, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL                                                                                                                                                                                                                                          
L0466003004PLANE, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISKS,                                                                                                                                                                                                                                       
L0466004004INCLUDES FITTING AND SHAPING THE FRAME, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                          
L0466005004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L0468001003TLSO, SAGITTAL-CORONAL CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT         TLSO rigid frame prefab pelv38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0468002004ANTERIOR APRON WITH STRAPS, CLOSURES AND PADDING, EXTENDS FROM SACROCOCCYGEAL                                                                                                                                                                                                                                        
L0468003004JUNCTION OVER SCAPULAE, LATERAL STRENGTH PROVIDED BY PELVIC, THORACIC, AND                                                                                                                                                                                                                                           
L0468004004LATERAL FRAME PIECES, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, AND CORONAL                                                                                                                                                                                                                                          
L0468005004PLANES, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISKS,                                                                                                                                                                                                                                      
L0468006004INCLUDES FITTING AND SHAPING THE FRAME, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                          
L0468007004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L0470001003TLSO, TRIPLANAR CONTROL, RIGID POSTERIOR FRAME AND FLEXIBLE SOFT ANTERIOR APRON TLSO rigid frame pre subclav38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0470002004WITH STRAPS, CLOSURES AND PADDING, EXTENDS FROM SACROCOCCYGEAL JUNCTION TO                                                                                                                                                                                                                                           
L0470003004SCAPULA, LATERAL STRENGTH PROVIDED BY PELVIC, THORACIC, AND LATERAL FRAME                                                                                                                                                                                                                                            
L0470004004PIECES, ROTATIONAL STRENGTH PROVIDED BY SUBCLAVICULAR EXTENSIONS, RESTRICTS                                                                                                                                                                                                                                          
L0470005004GROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND TRANVERSE PLANES, PRODUCES                                                                                                                                                                                                                                              
L0470006004INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISKS, INCLUDES                                                                                                                                                                                                                                          
L0470007004FITTING AND SHAPING THE FRAME, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                        
L0472001003TLSO, TRIPLANAR CONTROL, HYPEREXTENSION, RIGID ANTERIOR AND LATERAL FRAME       TLSO rigid frame hyperex pre38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0472002004EXTENDS FROM SYMPHYSIS PUBIS TO STERNAL NOTCH WITH TWO ANTERIOR COMPONENTS (ONE                                                                                                                                                                                                                                      
L0472003004PUBIC AND ONE STERNAL), POSTERIOR AND LATERAL PADS WITH STRAPS AND CLOSURES,                                                                                                                                                                                                                                         
L0472004004LIMITS SPINAL FLEXION, RESTRICTS GROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND                                                                                                                                                                                                                                        
L0472005004TRANSVERSE PLANES, INCLUDES FITTING AND SHAPING THE FRAME, PREFABRICATED,                                                                                                                                                                                                                                            
L0472006004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0476001003TLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC   TLSO flexion compres jac pre38      A                                                                                                     C                          D1F P      0200301012005010120041231N                           
L0476002004SHELLS WITH SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                           
L0476003004TERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS                                                                                                                                                                                                                                      
L0476004004TO XIPHOID, USUALLY LACED TOGETHER ON ONE SIDE, RESTRICTS GROSS TRUNK MOTION IN                                                                                                                                                                                                                                      
L0476005004SAGITTAL AND CORONAL PLANES, ALLOWS FREE FLEXION AND COMPRESSION OF THE LS                                                                                                                                                                                                                                           
L0476006004REGION, INCLUDES STRAPS AND CLOSURES, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                            
L0476007004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L0478001003TLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC   TLSO flexion compres jac cus38      A                                                                                                     C                          D1F P      0200301012005010120041231N                           
L0478002004SHELLS WITH SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                           
L0478003004TERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS                                                                                                                                                                                                                                      
L0478004004TO XIPHOID, USUALLY LACED TOGETHER ON ONE SIDE, RESTRICTS GROSS TRUNK MOTION IN                                                                                                                                                                                                                                      
L0478005004SAGITTAL AND CORONAL PLANES, ALLOWS FREE FLEXION AND COMPRESSION OF LS REGION,                                                                                                                                                                                                                                       
L0478006004INCLUDES STRAPS AND CLOSURES, CUSTOM FABRICATED                                                                                                                                                                                                                                                                      
L0480001003TLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITHOUT INTERFACE LINER, TLSO rigid plastic custom fa38      A                                                                                                     C                          D1F P      02003010120040101        N                           
L0480002004WITH MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL                                                                                                                                                                                                                                             
L0480003004JUNCTION AND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM                                                                                                                                                                                                                                       
L0480004004SYMPHYSIS PUBIS TO STERNAL NOTCH, ANTERIOR OR POSTERIOR OPENING, RESTRICTS                                                                                                                                                                                                                                           
L0480005004GROSS TRUNK MOTION IN SAGITTAL, CORONAL, AND TRANSVERSE PLANES, INCLUDES A                                                                                                                                                                                                                                           
L0480006004CARVED PLASTER OR CAD-CAM MODEL, CUSTOM FABRICATED                                                                                                                                                                                                                                                                   
L0482001003TLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER,    TLSO rigid lined custom fab 38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0482002004MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION                                                                                                                                                                                                                                         
L0482003004AND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS                                                                                                                                                                                                                                      
L0482004004PUBIS TO STERNAL NOTCH, ANTERIOR OR POSTERIOR OPENING, RESTRICTS GROSS TRUNK                                                                                                                                                                                                                                         
L0482005004MOTION IN SAGITTAL, CORONAL, AND TRANSVERSE PLANES, INCLUDES A CARVED PLASTER                                                                                                                                                                                                                                        
L0482006004OR CAD-CAM MODEL, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                  
L0484001003TLSO, TRIPLANAR CONTROL, TWO PIECE RIGID PLASTIC SHELL WITHOUT INTERFACE LINER, TLSO rigid plastic cust fab 38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0484002004WITH MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL                                                                                                                                                                                                                                             
L0484003004JUNCTION AND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM                                                                                                                                                                                                                                       
L0484004004SYMPHYSIS PUBIS TO STERNAL NOTCH, LATERAL STRENGTH IS ENHANCED BY OVERLAPPING                                                                                                                                                                                                                                        
L0484005004PLASTIC, RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL, AND TRANSVERSE                                                                                                                                                                                                                                       
L0484006004PLANES, INCLUDES A CARVED PLASTER OR CAD-CAM MODEL, CUSTOM FABRICATED                                                                                                                                                                                                                                                
L0486001003TLSO, TRIPLANAR CONTROL, TWO PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER,    TLSO rigidlined cust fab two38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0486002004MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION                                                                                                                                                                                                                                         
L0486003004AND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS                                                                                                                                                                                                                                      
L0486004004PUBIS TO STERNAL NOTCH, LATERAL STRENGTH IS ENHANCED BY OVERLAPPING PLASTIC,                                                                                                                                                                                                                                         
L0486005004RESTRICTS GROSS TRUNK MOTION IN THE SAGITTAL, CORONAL, AND TRANSVERSE PLANES,                                                                                                                                                                                                                                        
L0486006004INCLUDES A CARVED PLASTER OR CAD-CAM MODEL, CUSTOM FABRICATED                                                                                                                                                                                                                                                        
L0488001003TLSO, TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER,    TLSO rigid lined pre one pie38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0488002004MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION                                                                                                                                                                                                                                         
L0488003004AND TERMINATES JUST INFERIOR TO SCAPULAR SPINE, ANTERIOR EXTENDS FROM SYMPHYSIS                                                                                                                                                                                                                                      
L0488004004PUBIS TO STERNAL NOTCH, ANTERIOR OR POSTERIOR OPENING, RESTRICTS GROSS TRUNK                                                                                                                                                                                                                                         
L0488005004MOTION IN SAGITTAL, CORONAL, AND TRANSVERSE PLANES, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                          
L0488006004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L0490001003TLSO, SAGITTAL-CORONAL CONTROL, ONE PIECE RIGID PLASTIC SHELL, WITH OVERLAPPING TLSO rigid plastic pre one  38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L0490002004REINFORCED ANTERIOR, WITH MULTIPLE STRAPS AND CLOSURES, POSTERIOR EXTENDS FROM                                                                                                                                                                                                                                       
L0490003004SACROCOCCYGEAL JUNCTION AND TERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                       
L0490004004EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, ANTERIOR OPENING, RESTRICTS GROSS                                                                                                                                                                                                                                           
L0490005004TRUNK MOTION IN SAGITTAL AND CORONAL PLANES, PREFABRICATED, INCLUDES FITTING                                                                                                                                                                                                                                         
L0490006004AND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L0491001003TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID      TLSO 2 piece rigid shell    38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0491002004PLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                               
L0491003004TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE                                                                                                                                                                                                                                            
L0491004004SYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE                                                                                                                                                                                                                                      
L0491005004SAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                             
L0491006004PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L0491007004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0492001003TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID    TLSO 3 piece rigid shell    38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0492002004PLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND                                                                                                                                                                                                                                               
L0492003004TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE                                                                                                                                                                                                                                            
L0492004004SYMPHYSIS PUBIS TO THE XIPHOID, SOFT LINER, RESTRICTS GROSS TRUNK MOTION IN THE                                                                                                                                                                                                                                      
L0492005004SAGITTAL AND CORONAL PLANES, LATERAL STRENGTH IS PROVIDED BY OVERLAPPING                                                                                                                                                                                                                                             
L0492006004PLASTIC AND STABILIZING CLOSURES, INCLUDES STRAPS AND CLOSURES, PREFABRICATED,                                                                                                                                                                                                                                       
L0492007004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0500001003LUMBAR-SACRAL-ORTHOSIS (LSO), FLEXIBLE, (LUMBO-SACRAL SUPPORT)                  Lso flex surgical support   38      A                                                                                                     C                          D1F P      0198601012005010120041231N                           
L0510001003LSO, FLEXIBLE (LUMBO-SACRAL SUPPORT), CUSTOM FABRICATED                         Lso flexible custom fabricat38      A                                                                                                     C                          D1F P      0198201012005010120041231N                           
L0515001003LSO, ANTERIOR-POSTERIOR CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL,      Lso flex elas w/ rig post pa38      A                                                                                                     C                          D1F P      0198801012005010120041231N                           
L0515002004PREFABRICATED                                                                                                                                                                                                                                                                                                        
L0520001003LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL (KNIGHT, WILCOX TYPES), WITH APRON FRONTLso a-p-l control with apron38      A                                                                                                     C                          D1F P      0198501012005010120041231N                           
L0530001003LSO, ANTERIOR-POSTERIOR CONTROL (MACAUSLAND TYPE), WITH APRON FRONT             Lso ant-pos control w apron 38      A                                                                                                     C                          D1F P      0198401012005010120041231N                           
L0540001003LSO, LUMBAR FLEXION (WILLIAMS FLEXION TYPE)                                     Lso lumbar flexion a-p-l    38      A                                                                                                     C                          D1F P      0198501012005010120041231N                           
L0550001003LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL                Lso a-p-l control molded    38      A                                                                                                     C                          D1F P      0198401012005010120041231N                           
L0560001003LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL, WITH          Lso a-p-l w interface       38      A                                                                                                     C                          D1F P      0198601012005010120041231N                           
L0560002004INTERFACE MATERIAL                                                                                                                                                                                                                                                                                                   
L0561001003LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR     Prefab lso                  38      A                                                                                                     C                          D1F P      0200201012005010120041231N                           
L0561002004PANEL, PREFABRICATED                                                                                                                                                                                                                                                                                                 
L0565001003LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, CUSTOM FITTED                          Lso a-p-l control custom    38      A                                                                                                     C                          D1F P      0198801012005010120041231N                           
L0600001003SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT),                             Sacroiliac flex surg support38      A                                                                                                     C                          D1F P      0198201012005010120041231N                           
L0610001003SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT), CUSTOM FABRICATED           Sacroiliac flexible custm fa38      A                                                                                                     C                          D1F P      0198201012005010120041231N                           
L0620001003SACROILIAC, SEMI-RIGID (GOLDTHWAITE, OSGOOD TYPES), WITH APRON FRONT            Sacroiliac semi-rig w apron 38      A                                                                                                     C                          D1F P      0198201012005010120041231N                           
L0621001003SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION   SIO flex pelvisacral prefab 38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0621002004ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS                                                                                                                                                                                                                                         
L0621003004ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
L0622001003SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION   SIO flex pelvisacral custom 38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0622002004ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS                                                                                                                                                                                                                                         
L0622003004ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                    
L0623001003SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID   SIO panel prefab            38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0623002004PANELS OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT,                                                                                                                                                                                                                                       
L0623003004INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                      
L0623004004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0624001003SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID   SIO panel custom            38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0624002004PANELS PLACED OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC                                                                                                                                                                                                                                       
L0624003004JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM                                                                                                                                                                                                                                       
L0624004004FABRICATED                                                                                                                                                                                                                                                                                                           
L0625001003LUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT, POSTERIOR EXTENDS FROM L-1  LO flexibl L1-below L5 pre  38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0625002004TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE                                                                                                                                                                                                                                         
L0625003004INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN                                                                                                                                                                                                                                       
L0625004004DESIGN, SHOULDER STRAPS, STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                       
L0626001003LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR     LO sag stays/panels pre-fab 38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0626002004EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                           
L0626003004REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE                                                                                                                                                                                                                                      
L0626004004PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                            
L0626005004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0627001003LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS,    LO sagitt rigid panel prefab38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0627002004POSTERIOR EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                             
L0627003004PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L0627004004MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                       
L0627005004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0628001003LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR      LO flex w/o rigid stays pre 38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0628002004EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                         
L0628003004PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L0628004004MAY INCLUDE STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                         
L0628005004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0629001003LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR      LSO flex w/rigid stays cust 38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0629002004EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                         
L0629003004PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L0629004004MAY INCLUDE STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                      
L0630001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S),        LSO post rigid panel pre    38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0630002004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES                                                                                                                                                                                                                                             
L0630003004INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES                                                                                                                                                                                                                                          
L0630004004STRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS                                                                                                                                                                                                                                             
L0630005004ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                       
L0631001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR     LSO sag-coro rigid frame pre38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0631002004PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                              
L0631003004PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,                                                                                                                                                                                                                                          
L0631004004INCLUDES STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                       
L0631005004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L0632001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR     LSO sag rigid frame cust    38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0632002004PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                              
L0632003004PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS,                                                                                                                                                                                                                                          
L0632004004INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS                                                                                                                                                                                                                                           
L0632005004ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                    
L0633001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR          LSO flexion control prefab  38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0633002004FRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                      
L0633003004LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                      
L0633004004PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
L0633005004INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                                   
L0633006004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L0634001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR          LSO flexion control custom  38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0634002004FRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA,                                                                                                                                                                                                                                      
L0634003004LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANEL(S), PRODUCES                                                                                                                                                                                                                                                  
L0634004004INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
L0634005004CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER STRAPS, PENDULOUS ABDOMEN                                                                                                                                                                                                                                             
L0634006004DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                            
L0635001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID         LSO sagit rigid panel prefab38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0635002004POSTERIOR FRAME/PANEL(S), LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE,                                                                                                                                                                                                                                      
L0635003004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL                                                                                                                                                                                                                                              
L0635004004STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANEL(S), PRODUCES INTRACAVITARY                                                                                                                                                                                                                                            
L0635005004PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
L0635006004INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, PREFABRICATED,                                                                                                                                                                                                                                            
L0635007004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L0636001003LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID         LSO sagittal rigid panel cus38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0636002004POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE,                                                                                                                                                                                                                                        
L0636003004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL                                                                                                                                                                                                                                              
L0636004004STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY                                                                                                                                                                                                                                              
L0636005004PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY                                                                                                                                                                                                                                      
L0636006004INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                         
L0637001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND       LSO sag-coronal panel prefab38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0637002004POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9                                                                                                                                                                                                                                        
L0637003004VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES                                                                                                                                                                                                                                          
L0637004004INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
L0637005004CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                            
L0637006004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L0638001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND       LSO sag-coronal panel custom38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0638002004POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9                                                                                                                                                                                                                                        
L0638003004VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES                                                                                                                                                                                                                                          
L0638004004INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS,                                                                                                                                                                                                                                      
L0638005004CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN,                                                                                                                                                                                                                                            
L0638006004CUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
L0639001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S),      LSO s/c shell/panel prefab  38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0639002004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                             
L0639003004EXTENDS FROM SYMPHYSIS PUBIS TO XYPHOID, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                          
L0639004004REDUCE LOAD ON THE INTERVERTEBRAL DISCS, OVERALL STRENGTH IS PROVIDED BY                                                                                                                                                                                                                                             
L0639005004OVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L0639006004MAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                        
L0639007004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L0640001003LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S),      LSO s/c shell/panel custom  38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0640002004POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR                                                                                                                                                                                                                                             
L0640003004EXTENDS FROM SYMPHYSIS PUBIS TO XYPHOID, PRODUCES INTRACAVITARY PRESSURE TO                                                                                                                                                                                                                                          
L0640004004REDUCE LOAD ON THE INTERVERTEBRAL DISCS, OVERALL STRENGTH IS PROVIDED BY                                                                                                                                                                                                                                             
L0640005004OVERLAPPING RIGID MATERIAL AND STABILIZING CLOSURES, INCLUDES STRAPS, CLOSURES,                                                                                                                                                                                                                                      
L0640006004MAY INCLUDE SOFT INTERFACE, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED                                                                                                                                                                                                                                              
L0700001003CERVICAL-THORACIC-LUMBAR-SACRAL-ORTHOSES (CTLSO), ANTERIOR-POSTERIOR-LATERAL    Ctlso a-p-l control molded  38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L0700002004CONTROL, MOLDED TO PATIENT MODEL, (MINERVA TYPE)                                                                                                                                                                                                                                                                     
L0710001003CTLSO, ANTERIOR-POSTERIOR-LATERAL-CONTROL, MOLDED TO PATIENT MODEL, WITH        Ctlso a-p-l control w/ inter38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L0710002004INTERFACE MATERIAL, (MINERVA TYPE)                                                                                                                                                                                                                                                                                   
L0810001003HALO PROCEDURE,  CERVICAL HALO INCORPORATED INTO JACKET VEST                    Halo cervical into jckt vest38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L0820001003HALO PROCEDURE,  CERVICAL HALO INCORPORATED INTO PLASTER BODY JACKET            Halo cervical into body jack38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L0830001003HALO PROCEDURE,  CERVICAL HALO INCORPORATED INTO MILWAUKEE TYPE ORTHOSIS        Halo cerv into milwaukee typ38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L0859001003ADDITION TO HALO PROCEDURE, MAGNETIC RESONANCE IMAGE COMPATIBLE SYSTEMS, RINGS  MRI compatible system       38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L0859002004AND PINS, ANY MATERIAL                                                                                                                                                                                                                                                                                               
L0860001003ADDITION TO HALO PROCEDURES, MAGNETIC REASONANCE IMAGE COMPATIBLE SYSTEM        Magnetic resonanc image comp38      A                                                                            L0859                    C                          D1F P      0198901012006010120051231D                           
L0861001003ADDITION TO HALO PROCEDURE, REPLACEMENT LINER/INTERFACE MATERIAL                Halo repl liner/interface   38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L0900001003TORSO SUPPORT,  PTOSIS SUPPORT                                                  Torso/ptosis support        38      A                                                                            L0500                    C                          D1F P      0198601012003010120021231N                           
L0910001003TORSO SUPPORT,  PTOSIS SUPPORT, CUSTOM FABRICATED                               Torso & ptosis supp custm fa38      A                                                                            L0510                    C                          D1F P      0198601012003010120021231N                           
L0920001003TORSO SUPPORT,  PENDULOUS ABDOMEN SUPPORT                                       Torso/pendulous abd support 38      A                                                                            L0500                    C                          D1F P      0198601012003010120021231N                           
L0930001003TORSO SUPPORT,  PENDULOUS ABDOMEN SUPPORT, CUSTOM FABRICATED                    Pendulous abdomen supp custm38      A                                                                            L0510                    C                          D1F P      0198601012003010120021231N                           
L0940001003TORSO SUPPORT,  POSTSURGICAL SUPPORT                                            Torso/postsurgical support  38      A                                                                            L0500                    C                          D1F P      0198601012003010120021231N                           
L0950001003TORSO SUPPORT,  POST SURGICAL SUPPORT, CUSTOM FABRICATED                        Post surg support custom fab38      A                                                                            L0510                    C                          D1F P      0198601012003010120021231N                           
L0960001003TORSO SUPPORT,  POST SURGICAL SUPPORT, PADS FOR POST SURGICAL SUPPORT           Post surgical support pads  38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L0970001003TLSO, CORSET FRONT                                                              Tlso corset front           38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0972001003LSO, CORSET FRONT                                                               Lso corset front            38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0974001003TLSO, FULL CORSET                                                               Tlso full corset            38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0976001003LSO, FULL CORSET                                                                Lso full corset             38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0978001003AXILLARY CRUTCH EXTENSION                                                       Axillary crutch extension   38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0980001003PERONEAL STRAPS, PAIR                                                           Peroneal straps pair        38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L0982001003STOCKING SUPPORTER GRIPS, SET OF FOUR (4)                                       Stocking supp grips set of f38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0984001003PROTECTIVE BODY SOCK, EACH                                                      Protective body sock each   38      A                                                                                                     C                          D1F P      01994010119960101        N                           
L0986001003ADDITION TO SPINAL ORTHOSIS, RIGID OR SEMI-RIGID ABDOMINAL PANEL, PREFABRICATED Spinal orth abdm pnl prefab 38      A                                                                                                     C                          D1F P      0200201012003010120021231N                           
L0999001003ADDITION TO SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED                            Add to spinal orthosis NOS  46      A                                                                                                     C                          D1F P      01998010119980101        N                           
L1000001003CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) (MILWAUKEE), INCLUSIVE OF      Ctlso milwauke initial model38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1000002004FURNISHING INITIAL ORTHOSIS, INCLUDING MODEL                                                                                                                                                                                                                                                                         
L1005001003TENSION BASED SCOLIOSIS ORTHOSIS AND ACCESSORY PADS, INCLUDES FITTING AND       Tension based scoliosis orth38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L1005002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L1010001003ADDITION TO CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) OR SCOLIOSIS       Ctlso axilla sling          38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1010002004ORTHOSIS, AXILLA SLING                                                                                                                                                                                                                                                                                               
L1020001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD                           Kyphosis pad                38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1025001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD, FLOATING                 Kyphosis pad floating       38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L1030001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR BOLSTER PAD                     Lumbar bolster pad          38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1040001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR OR LUMBAR RIB PAD               Lumbar or lumbar rib pad    38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1050001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, STERNAL PAD                            Sternal pad                 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1060001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, THORACIC PAD                           Thoracic pad                38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1070001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, TRAPEZIUS SLING                        Trapezius sling             38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1080001003ADDITION  TO CTLSO OR SCOLIOSIS ORTHOSIS, OUTRIGGER                             Outrigger                   38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1085001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, OUTRIGGER, BILATERAL WITH VERTICAL     Outrigger bil w/ vert extens38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L1085002004EXTENSIONS                                                                                                                                                                                                                                                                                                           
L1090001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR SLING                           Lumbar sling                38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1100001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, RING FLANGE, PLASTIC OR LEATHER        Ring flange plastic/leather 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1110001003ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, RING FLANGE, PLASTIC OR LEATHER,       Ring flange plas/leather mol38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1110002004MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                              
L1120001003ADDITION TO CTLSO, SCOLIOSIS ORTHOSIS, COVER FOR UPRIGHT, EACH                  Covers for upright each     38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1200001003THORACIC-LUMBAR-SACRAL-ORTHOSIS (TLSO), INCLUSIVE OF FURNISHING INITIAL         Furnsh initial orthosis only38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1200002004ORTHOSIS ONLY                                                                                                                                                                                                                                                                                                        
L1210001003ADDITION TO TLSO, (LOW PROFILE), LATERAL THORACIC EXTENSION                     Lateral thoracic extension  38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1220001003ADDITION TO TLSO, (LOW PROFILE), ANTERIOR THORACIC EXTENSION                    Anterior thoracic extension 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1230001003ADDITION TO TLSO, (LOW PROFILE), MILWAUKEE TYPE SUPERSTRUCTURE                  Milwaukee type superstructur38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1240001003ADDITION TO TLSO, (LOW PROFILE), LUMBAR DEROTATION PAD                          Lumbar derotation pad       38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L1250001003ADDITION TO TLSO, (LOW PROFILE), ANTERIOR ASIS PAD                              Anterior asis pad           38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L1260001003ADDITION TO TLSO, (LOW PROFILE), ANTERIOR THORACIC DEROTATION PAD               Anterior thoracic derotation38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L1270001003ADDITION TO TLSO, (LOW PROFILE), ABDOMINAL PAD                                  Abdominal pad               38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L1280001003ADDITION TO TLSO, (LOW PROFILE), RIB GUSSET (ELASTIC), EACH                     Rib gusset (elastic) each   38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L1290001003ADDITION TO TLSO, (LOW PROFILE), LATERAL TROCHANTERIC PAD                       Lateral trochanteric pad    38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L1300001003OTHER SCOLIOSIS PROCEDURE, BODY JACKET MOLDED TO PATIENT MODEL                  Body jacket mold to patient 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1310001003OTHER SCOLIOSIS PROCEDURE,  POST-OPERATIVE BODY JACKET                          Post-operative body jacket  38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1499001003SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED                                        Spinal orthosis NOS         46      A                                                                                                     C                          D1F P      01982010119980101        N                           
L1500001003THORACIC-HIP-KNEE-ANKLE ORTHOSIS (THKAO), MOBILITY FRAME (NEWINGTON, PARAPODIUM Thkao mobility frame        38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L1500002004TYPES)                                                                                                                                                                                                                                                                                                               
L1510001003THKAO, STANDING FRAME, WITH OR WITHOUT TRAY AND ACCESSORIES                     Thkao standing frame        38      A                                                                                                     C                          D1F P      01982010120020101        N                           
L1520001003THKAO, SWIVEL WALKER                                                            Thkao swivel walker         38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L1600001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, FREJKA TYPE WITH       Abduct hip flex frejka w cvr38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L1600002004COVER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                
L1610001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (FREJKA COVER ONLY),   Abduct hip flex frejka covr 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1610002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L1620001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, (PAVLIK HARNESS),      Abduct hip flex pavlik harne38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1620002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L1630001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, SEMI-FLEXIBLE (VON ROSEN TYPE),  Abduct control hip semi-flex38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1630002004CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L1640001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, PELVIC BAND OR SPREADER  Pelv band/spread bar thigh c38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1640002004BAR, THIGH CUFFS, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                  
L1650001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, ADJUSTABLE, (ILFLED      HO abduction hip adjustable 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1650002004TYPE), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                
L1652001003HIP ORTHOSIS, BILATERAL THIGH CUFFS WITH ADJUSTABLE ABDUCTOR SPREADER BAR,      HO bi thighcuffs w sprdr bar38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L1652002004ADULT SIZE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT, ANY TYPE                                                                                                                                                                                                                                                 
L1660001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, STATIC, PLASTIC, PREFABRICATED,  HO abduction static plastic 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1660002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L1680001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINTS, DYNAMIC, PELVIC CONTROL,         Pelvic & hip control thigh c38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1680002004ADJUSTABLE HIP MOTION CONTROL, THIGH CUFFS (RANCHO HIP ACTION TYPE), CUSTOM                                                                                                                                                                                                                                          
L1680003004FABRICATED                                                                                                                                                                                                                                                                                                           
L1685001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE, Post-op hip abduct custom fa38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L1685002004CUSTOM FABRICATED                                                                                                                                                                                                                                                                                                    
L1686001003HIP ORTHOSIS, ABDUCTION CONTROL OF HIP JOINT, POSTOPERATIVE HIP ABDUCTION TYPE, HO post-op hip abduction    38      A                                                                                                     C                          D1F P      01989010120010101        N                           
L1686002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L1690001003COMBINATION, BILATERAL, LUMBO-SACRAL, HIP, FEMUR ORTHOSIS PROVIDING ADDUCTION   Combination bilateral HO    38      A                                                                                                     C                          D1F P      01999010120010101        N                           
L1690002004AND INTERNAL ROTATION CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                        
L1700001003LEGG PERTHES ORTHOSIS, (TORONTO TYPE), CUSTOM-FABRICATED                        Leg perthes orth toronto typ38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1710001003LEGG PERTHES ORTHOSIS, (NEWINGTON TYPE), CUSTOM FABRICATED                      Legg perthes orth newington 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1720001003LEGG PERTHES ORTHOSIS, TRILATERAL, (TACHDIJAN TYPE), CUSTOM-FABRICATED          Legg perthes orthosis trilat38      A                                                                                                     C                          D1F P      01985010120010101        N                           
L1730001003LEGG PERTHES ORTHOSIS, (SCOTTISH RITE TYPE), CUSTOM-FABRICATED                  Legg perthes orth scottish r38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1750001003LEGG PERTHES ORTHOSIS, LEGG PERTHES SLING (SAM BROWN TYPE), PREFABRICATED,      Legg perthes sling          38      A                                                                            A4565                    C                          D1F P      0198201012006010120051231D                           
L1750002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L1755001003LEGG PERTHES ORTHOSIS, (PATTEN BOTTOM TYPE), CUSTOM-FABRICATED                  Legg perthes patten bottom t38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L1800001003KNEE ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND          Knee orthoses elas w stays  38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L1800002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L1810001003KNEE ORTHOSIS, ELASTIC WITH JOINTS, PREFABRICATED, INCLUDES FITTING AND         Ko elastic with joints      38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1810002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L1815001003KNEE ORTHOSIS, ELASTIC OR OTHER ELASTIC TYPE MATERIAL WITH CONDYLAR PAD(S),     Elastic with condylar pads  38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L1815002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L1820001003KNEE ORTHOSIS, ELASTIC WITH CONDYLAR PADS AND JOINTS, WITH OR WITHOUT PATELLAR  Ko elas w/ condyle pads & jo38      A                                                                                                     C                          D1F P      01986010120050101        N                           
L1820002004CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                              
L1825001003KNEE ORTHOSIS, ELASTIC KNEE CAP, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT Ko elastic knee cap         38      A                                                                                                     C                          D1F P      01985010120010101        N                           
L1830001003KNEE ORTHOSIS, IMMOBILIZER, CANVAS LONGITUDINAL, PREFABRICATED, INCLUDES        Ko immobilizer canvas longit38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L1830002004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L1831001003KNEE ORTHOSIS, LOCKING KNEE JOINT(S), POSITIONAL ORTHOSIS, PREFABRICATED,       Knee orth pos locking joint 38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L1831002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L1832001003KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL   KO adj jnt pos rigid support38      A                                                                                                     C                          D1F P      01989010120060101        C                           
L1832002004ORTHOSIS, RIGID SUPPORT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                              
L1834001003KNEE ORTHOSIS, WITHOUT KNEE JOINT, RIGID, CUSTOM-FABRICATED                     Ko w/0 joint rigid molded to38      A                                                                                                     C                          D1F P      01989010120010101        N                           
L1836001003KNEE ORTHOSIS, RIGID, WITHOUT JOINT(S), INCLUDES SOFT INTERFACE MATERIAL,       Rigid KO wo joints          38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L1836002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L1840001003KNEE ORTHOSIS, DEROTATION, MEDIAL-LATERAL, ANTERIOR CRUCIATE LIGAMENT, CUSTOM   Ko derot ant cruciate custom38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L1840002004FABRICATED                                                                                                                                                                                                                                                                                                           
L1843001003KNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND      KO single upright custom fit38      A                                                                                                     C                          D1F P      01998010120060101        C                           
L1843002004EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION                                                                                                                                                                                                                                             
L1843003004CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT,  PREFABRICATED, INCLUDES                                                                                                                                                                                                                                           
L1843004004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L1844001003KNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND      Ko w/adj jt rot cntrl molded38      A                                                                                                     C                          D1F P      01993010120060101        C                           
L1844002004EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION                                                                                                                                                                                                                                             
L1844003004CONTROL, WITH OR WITHOUT  VARUS/VALGUS ADJUSTMENT, CUSTOM FABRICATED                                                                                                                                                                                                                                                 
L1845001003KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND      Ko w/ adj flex/ext rotat cus38      A                                                                                                     C                          D1F P      01988010120060101        C                           
L1845002004EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION                                                                                                                                                                                                                                             
L1845003004CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PREFABRICATED, INCLUDES                                                                                                                                                                                                                                            
L1845004004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L1846001003KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND      Ko w adj flex/ext rotat mold38      A                                                                                                     C                          D1F P      01988010120060101        C                           
L1846002004EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION                                                                                                                                                                                                                                             
L1846003004CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, CUSTOM FABRICATED                                                                                                                                                                                                                                                  
L1847001003KNEE ORTHOSIS, DOUBLE UPRIGHT WITH ADJUSTABLE JOINT, WITH INFLATABLE AIR        KO adjustable w air chambers38      A                                                                                                     C                          D1F P      01999010120010101        N                           
L1847002004SUPPORT CHAMBER(S), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                   
L1850001003KNEE ORTHOSIS, SWEDISH TYPE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT     Ko swedish type             38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1855001003KNEE ORTHOSIS, MOLDED PLASTIC, THIGH AND CALF SECTIONS, WITH DOUBLE UPRIGHT     Ko plas doub upright jnt mol38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L1855002004KNEE JOINTS, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                       
L1858001003KNEE ORTHOSIS, MOLDED PLASTIC, POLYCENTRIC KNEE JOINTS, PNEUMATIC KNEE PADS     Ko polycentric pneumatic pad38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L1858002004(CTI), CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                             
L1860001003KNEE ORTHOSIS, MODIFICATION OF SUPRACONDYLAR PROSTHETIC SOCKET,                 Ko supracondylar socket mold38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1860002004CUSTOM-FABRICATED (SK)                                                                                                                                                                                                                                                                                               
L1870001003KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF LACERS WITH KNEE JOINTS,          Ko doub upright lacers molde38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1870002004CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L1880001003KNEE ORTHOSIS, DOUBLE UPRIGHT, NON-MOLDED THIGH AND CALF CUFFS/LACERS WITH KNEE Ko doub upright cuffs/lacers38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1880002004JOINTS, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                            
L1885001003KNEE ORTHOSIS, SINGLE OR DOUBLE UPRIGHT, THIGH AND CALF, WITH FUNCTIONAL ACTIVE Knee upright w/resistance   38      A                                                                            E1810                    C                          D1F P      0199601012004010120031231N                           
L1885002004RESISTANCE CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                   
L1900001003ANKLE FOOT ORTHOSIS, SPRING WIRE, DORSIFLEXION ASSIST CALF BAND,                Afo sprng wir drsflx calf bd38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L1900002004CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L1901001003ANKLE ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G.   Prefab ankle orthosis       38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L1901002004NEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                                     
L1902001003ANKLE FOOT ORTHOSIS, ANKLE GAUNTLET, PREFABRICATED, INCLUDES FITTING AND        Afo ankle gauntlet          38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L1902002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L1904001003ANKLE FOOT ORTHOSIS, MOLDED ANKLE GAUNTLET, CUSTOM-FABRICATED                   Afo molded ankle gauntlet   38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L1906001003ANKLE FOOT ORTHOSIS, MULTILIGAMENTUS ANKLE SUPPORT, PREFABRICATED, INCLUDES     Afo multiligamentus ankle su38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L1906002004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L1907001003AFO, SUPRAMALLEOLAR WITH STRAPS, WITH OR WITHOUT INTERFACE/PADS, CUSTOM         AFO supramalleolar custom   38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L1907002004FABRICATED                                                                                                                                                                                                                                                                                                           
L1910001003ANKLE FOOT ORTHOSIS, POSTERIOR, SINGLE BAR, CLASP ATTACHMENT TO SHOE COUNTER,   Afo sing bar clasp attach sh38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1910002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L1920001003ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT WITH STATIC OR ADJUSTABLE STOP (PHELPS OR   Afo sing upright w/ adjust s38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1920002004PERLSTEIN TYPE), CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                   
L1930001003ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING Afo plastic                 38      A                                                                                                     C                          D1F P      01982010120020101        N                           
L1930002004AND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L1932001003AFO, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL,       Afo rig ant tib prefab TCF/=38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L1932002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L1940001003ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, CUSTOM-FABRICATED               Afo molded to patient plasti38      A                                                                                                     C                          D1F P      01982010120020101        N                           
L1945001003ANKLE FOOT ORTHOSIS, PLASTIC, RIGID ANTERIOR TIBIAL SECTION (FLOOR REACTION),   Afo molded plas rig ant tib 38      A                                                                                                     C                          D1F P      01989010120010101        N                           
L1945002004CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L1950001003ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE),       Afo spiral molded to pt plas38      A                                                                                                     C                          D1F P      01982010120040101        N                           
L1950002004PLASTIC, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                           
L1951001003ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE),       AFO spiral prefabricated    38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L1951002004PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                            
L1960001003ANKLE FOOT ORTHOSIS, POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM-FABRICATED          Afo pos solid ank plastic mo38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1970001003ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM-FABRICATED                Afo plastic molded w/ankle j38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1971001003ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, PREFABRICATED, AFO w/ankle joint, prefab   38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L1971002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L1980001003ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP,   Afo sing solid stirrup calf 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1980002004CALF BAND/CUFF (SINGLE BAR 'BK' ORTHOSIS), CUSTOM-FABRICATED                                                                                                                                                                                                                                                         
L1990001003ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP,   Afo doub solid stirrup calf 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1990002004CALF BAND/CUFF (DOUBLE BAR 'BK' ORTHOSIS), CUSTOM-FABRICATED                                                                                                                                                                                                                                                         
L2000001003KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE KNEE, FREE ANKLE, SOLID STIRRUP, Kafo sing fre stirr thi/calf38      A                                                                                                     C                          D1F P      01985010120010101        N                           
L2000002004THIGH AND CALF BANDS/CUFFS (SINGLE BAR 'AK' ORTHOSIS), CUSTOM-FABRICATED                                                                                                                                                                                                                                             
L2005001003KNEE ANKLE FOOT ORTHOSIS, ANY MATERIAL, SINGLE OR DOUBLE UPRIGHT, STANCE        KAFO sng/dbl mechanical act 38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L2005002004CONTROL, AUTOMATIC LOCK AND SWING PHASE RELEASE, MECHANICAL ACTIVATION,                                                                                                                                                                                                                                              
L2005003004INCLUDES ANKLE JOINT, ANY TYPE, CUSTOM FABRICATED                                                                                                                                                                                                                                                                    
L2010001003KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND  Kafo sng solid stirrup w/o j38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L2010002004CALF BANDS/CUFFS (SINGLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT,                                                                                                                                                                                                                                                     
L2010003004CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L2020001003KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND  Kafo dbl solid stirrup band/38      A                                                                                                     C                          D1F P      01985010120010101        N                           
L2020002004CALF BANDS/CUFFS (DOUBLE BAR 'AK' ORTHOSIS), CUSTOM-FABRICATED                                                                                                                                                                                                                                                       
L2030001003KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND  Kafo dbl solid stirrup w/o j38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L2030002004CALF BANDS/CUFFS, (DOUBLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT, CUSTOM                                                                                                                                                                                                                                             
L2030003004FABRICATED                                                                                                                                                                                                                                                                                                           
L2034001003KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE    KAFO pla sin up w/wo k/a cus38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L2034002004MOTION KNEE, MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION                                                                                                                                                                                                                                            
L2034003004ANKLE, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                             
L2035001003KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, STATIC (PEDIATRIC SIZE), WITHOUT FREE   KAFO plastic pediatric size 38      A                                                                                                     C                          D1F P      01998010120050101        N                           
L2035002004MOTION ANKLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                         
L2036001003KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, DOUBLE UPRIGHT, WITH OR WITHOUT FREE    Kafo plas doub free knee mol38      A                                                                                                     C                          D1F P      01988010120060101        C                           
L2036002004MOTION KNEE, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED                                                                                                                                                                                                                                                    
L2037001003KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE    Kafo plas sing free knee mol38      A                                                                                                     C                          D1F P      01989010120060101        C                           
L2037002004MOTION KNEE, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED                                                                                                                                                                                                                                                    
L2038001003KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, WITH OR WITHOUT FREE MOTION KNEE,       Kafo w/o joint multi-axis an38      A                                                                                                     C                          D1F P      01989010120060101        C                           
L2038002004MULTI-AXIS ANKLE,  CUSTOM FABRICATED                                                                                                                                                                                                                                                                                 
L2039001003KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, POLY-AXIAL HINGE,       KAFO,plstic,medlat rotat con38      A                                                                                                     C                          D1F P      0199701012006010120051231D                           
L2039002004MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM                                                                                                                                                                                                                                           
L2039003004FABRICATED                                                                                                                                                                                                                                                                                                           
L2040001003HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL ROTATION STRAPS,       Hkafo torsion bil rot straps38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L2040002004PELVIC BAND/BELT, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                  
L2050001003HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, HIP    Hkafo torsion cable hip pelv38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L2050002004JOINT, PELVIC BAND/BELT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                           
L2060001003HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, BALL   Hkafo torsion ball bearing j38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L2060002004BEARING HIP JOINT, PELVIC BAND/ BELT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                              
L2070001003HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL ROTATION STRAPS,      Hkafo torsion unilat rot str38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L2070002004PELVIC BAND/BELT, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                  
L2080001003HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, HIP    Hkafo unilat torsion cable  38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L2080002004JOINT, PELVIC BAND/BELT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                           
L2090001003HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, BALL   Hkafo unilat torsion ball br38      A                                                                                                     C                          D1F P      01984010120010101        N                           
L2090002004BEARING HIP JOINT, PELVIC BAND/ BELT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                              
L2102001003ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, PLASTER  Afo tibial fx cast plstr mol00      9                                                                                                     I                          D1F P      0198801012004010120031231N                           
L2102002004TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                             
L2104001003ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS,          Afo tib fx cast synthetic mo00      9                                                                                                     I                          D1F P      0198801012004010120031231N                           
L2104002004SYNTHETIC TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                   
L2106001003ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS,          Afo tib fx cast plaster mold38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2106002004THERMOPLASTIC TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                               
L2108001003ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS,          Afo tib fx cast molded to pt38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2108002004CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L2112001003ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SOFT,         Afo tibial fracture soft    38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2112002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L2114001003ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI-RIGID,   Afo tib fx semi-rigid       38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2114002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L2116001003ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, RIGID,        Afo tibial fracture rigid   38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2116002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L2122001003KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,    Kafo fem fx cast plaster mol00      9                                                                                                     I                          D1F P      0198801012004010120031231N                           
L2122002004PLASTER TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                     
L2124001003KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,    Kafo fem fx cast synthet mol00      9                                                                                                     I                          D1F P      0198801012004010120031231N                           
L2124002004SYNTHETIC TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                   
L2126001003KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,    Kafo fem fx cast thermoplas 38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2126002004THERMOPLASTIC TYPE CASTING MATERIAL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                               
L2128001003KNEE ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS,    Kafo fem fx cast molded to p38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2128002004CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L2132001003KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SOFT, PREFABRICATED,   Kafo femoral fx cast soft   38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2132002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L2134001003KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, SEMI-RIGID,            Kafo fem fx cast semi-rigid 38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2134002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L2136001003KAFO, FRACTURE ORTHOSIS, FEMORAL FRACTURE CAST ORTHOSIS, RIGID, PREFABRICATED,  Kafo femoral fx cast rigid  38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2136002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L2180001003ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, PLASTIC SHOE INSERT WITH ANKLE   Plas shoe insert w ank joint38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2180002004JOINTS                                                                                                                                                                                                                                                                                                               
L2182001003ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, DROP LOCK KNEE JOINT             Drop lock knee              38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2184001003ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, LIMITED MOTION KNEE JOINT        Limited motion knee joint   38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2186001003ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, ADJUSTABLE MOTION KNEE JOINT,    Adj motion knee jnt lerman t38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2186002004LERMAN TYPE                                                                                                                                                                                                                                                                                                          
L2188001003ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, QUADRILATERAL BRIM               Quadrilateral brim          38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2190001003ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, WAIST BELT                       Waist belt                  38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2192001003ADDITION TO LOWER EXTREMITY FRACTURE ORTHOSIS, HIP JOINT, PELVIC BAND, THIGH    Pelvic band & belt thigh fla38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2192002004FLANGE, AND PELVIC BELT                                                                                                                                                                                                                                                                                              
L2200001003ADDITION TO LOWER EXTREMITY, LIMITED ANKLE MOTION, EACH JOINT                   Limited ankle motion ea jnt 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2210001003ADDITION TO LOWER EXTREMITY, DORSIFLEXION ASSIST (PLANTAR FLEXION RESIST), EACH Dorsiflexion assist each joi38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2210002004JOINT                                                                                                                                                                                                                                                                                                                
L2220001003ADDITION TO LOWER EXTREMITY, DORSIFLEXION AND PLANTAR FLEXION ASSIST/RESIST,    Dorsi & plantar flex ass/res38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2220002004EACH JOINT                                                                                                                                                                                                                                                                                                           
L2230001003ADDITION TO LOWER EXTREMITY, SPLIT FLAT CALIPER STIRRUPS AND PLATE ATTACHMENT   Split flat caliper stirr & p38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2232001003ADDITION TO LOWER EXTREMITY ORTHOSIS, ROCKER BOTTOM FOR TOTAL CONTACT ANKLE     Rocker bottom, contact AFO  38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L2232002004FOOT ORTHOSIS, FOR CUSTOM FABRICATED ORTHOSIS ONLY                                                                                                                                                                                                                                                                   
L2240001003ADDITION TO LOWER EXTREMITY, ROUND CALIPER AND PLATE ATTACHMENT                 Round caliper and plate atta38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2250001003ADDITION  TO LOWER EXTREMITY, FOOT PLATE, MOLDED TO PATIENT MODEL, STIRRUP      Foot plate molded stirrup at38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2250002004ATTACHMENT                                                                                                                                                                                                                                                                                                           
L2260001003ADDITION  TO LOWER EXTREMITY, REINFORCED SOLID STIRRUP (SCOTT-CRAIG TYPE)       Reinforced solid stirrup    38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2265001003ADDITION TO LOWER EXTREMITY, LONG TONGUE STIRRUP                                Long tongue stirrup         38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L2270001003ADDITION  TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION ('T') STRAP, PADDED/LINED Varus/valgus strap padded/li38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2270002004OR MALLEOLUS PAD                                                                                                                                                                                                                                                                                                     
L2275001003ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC MODIFICATION,     Plastic mod low ext pad/line38      A                                                                                                     C                          D1F P      01994010119960101        N                           
L2275002004PADDED/LINED                                                                                                                                                                                                                                                                                                         
L2280001003ADDITION  TO LOWER EXTREMITY, MOLDED INNER BOOT                                 Molded inner boot           38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2300001003ADDITION  TO LOWER EXTREMITY, ABDUCTION BAR (BILATERAL HIP INVOLVEMENT),        Abduction bar jointed adjust38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2300002004JOINTED, ADJUSTABLE                                                                                                                                                                                                                                                                                                  
L2310001003ADDITION  TO LOWER EXTREMITY, ABDUCTION BAR-STRAIGHT                            Abduction bar-straight      38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2320001003ADDITION TO LOWER EXTREMITY, NON-MOLDED LACER, FOR CUSTOM FABRICATED ORTHOSIS   Non-molded lacer            38      A                                                                                                     C                          D1F P      01986010120050101        N                           
L2320002004ONLY                                                                                                                                                                                                                                                                                                                 
L2330001003ADDITION TO LOWER EXTREMITY, LACER MOLDED TO PATIENT MODEL, FOR CUSTOM          Lacer molded to patient mode38      A                                                                                                     C                          D1F P      01986010120050101        N                           
L2330002004FABRICATED ORTHOSIS ONLY                                                                                                                                                                                                                                                                                             
L2335001003ADDITION  TO LOWER EXTREMITY, ANTERIOR SWING BAND                               Anterior swing band         38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2340001003ADDITION  TO LOWER EXTREMITY, PRE-TIBIAL SHELL, MOLDED TO PATIENT MODEL         Pre-tibial shell molded to p38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2350001003ADDITION  TO LOWER EXTREMITY, PROSTHETIC TYPE, (BK) SOCKET, MOLDED TO PATIENT   Prosthetic type socket molde38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2350002004MODEL, (USED FOR 'PTB' 'AFO' ORTHOSES)                                                                                                                                                                                                                                                                               
L2360001003ADDITION  TO LOWER EXTREMITY, EXTENDED STEEL SHANK                              Extended steel shank        38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2370001003ADDITION TO LOWER EXTREMITY, PATTEN BOTTOM                                      Patten bottom               38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2375001003ADDITION  TO LOWER EXTREMITY, TORSION CONTROL, ANKLE JOINT AND HALF SOLID       Torsion ank & half solid sti38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2375002004STIRRUP                                                                                                                                                                                                                                                                                                              
L2380001003ADDITION  TO LOWER EXTREMITY, TORSION CONTROL, STRAIGHT KNEE JOINT, EACH JOINT  Torsion straight knee joint 38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2385001003ADDITION  TO LOWER EXTREMITY, STRAIGHT KNEE JOINT, HEAVY DUTY, EACH JOINT       Straight knee joint heavy du38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2387001003ADDITION TO LOWER EXTREMITY, POLYCENTRIC KNEE JOINT, FOR CUSTOM FABRICATED KNEE Add LE poly knee custom KAFO38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L2387002004ANKLE FOOT ORTHOSIS, EACH JOINT                                                                                                                                                                                                                                                                                      
L2390001003ADDITION  TO LOWER EXTREMITY, OFFSET KNEE JOINT, EACH JOINT                     Offset knee joint each      38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2395001003ADDITION  TO LOWER EXTREMITY, OFFSET KNEE JOINT, HEAVY DUTY, EACH JOINT         Offset knee joint heavy duty38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2397001003ADDITION TO LOWER EXTREMITY ORTHOSIS, SUSPENSION SLEEVE                         Suspension sleeve lower ext 38      A                                                                                                     C                          D1F P      01994010119960101        N                           
L2405001003ADDITION TO KNEE JOINT, DROP LOCK, EACH                                         Knee joint drop lock ea jnt 38      A                                                                                                     C                          D1F P      01988010120060101        C                           
L2415001003ADDITION TO KNEE LOCK WITH INTEGRATED RELEASE MECHANISM ( BAIL, CABLE, OR       Knee joint cam lock each joi38      A                                                                                                     C                          D1F P      01988010120020101        N                           
L2415002004EQUAL), ANY MATERIAL, EACH JOINT                                                                                                                                                                                                                                                                                     
L2425001003ADDITION TO KNEE JOINT, DISC OR DIAL LOCK FOR ADJUSTABLE KNEE FLEXION, EACH     Knee disc/dial lock/adj flex38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2425002004JOINT                                                                                                                                                                                                                                                                                                                
L2430001003ADDITION TO KNEE JOINT, RATCHET LOCK FOR ACTIVE AND PROGRESSIVE KNEE EXTENSION, Knee jnt ratchet lock ea jnt38      A                                                                                                     C                          D1F P      01997010119970101        N                           
L2430002004EACH JOINT                                                                                                                                                                                                                                                                                                           
L2435001003ADDITION TO KNEE JOINT, POLYCENTRIC JOINT, EACH JOINT                           Knee joint polycentric joint38      A                                                                                                     C                          D1F P      0198801012005010120041231N                           
L2492001003ADDITION TO KNEE JOINT, LIFT LOOP FOR DROP LOCK RING                            Knee lift loop drop lock rin38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2500001003ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, GLUTEAL/ ISCHIAL WEIGHT      Thi/glut/ischia wgt bearing 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2500002004BEARING, RING                                                                                                                                                                                                                                                                                                        
L2510001003ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM, MOLDED Th/wght bear quad-lat brim m38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2510002004TO PATIENT MODEL                                                                                                                                                                                                                                                                                                     
L2520001003ADDITION  TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, QUADRI- LATERAL BRIM,       Th/wght bear quad-lat brim c38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2520002004CUSTOM FITTED                                                                                                                                                                                                                                                                                                        
L2525001003ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW   Th/wght bear nar m-l brim mo38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L2525002004M-L BRIM MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                     
L2526001003ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW   Th/wght bear nar m-l brim cu38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L2526002004M-L BRIM, CUSTOM FITTED                                                                                                                                                                                                                                                                                              
L2530001003ADDITION  TO LOWER EXTREMITY, THIGH-WEIGHT BEARING, LACER, NON-MOLDED           Thigh/wght bear lacer non-mo38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2540001003ADDITION  TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, LACER, MOLDED TO PATIENT    Thigh/wght bear lacer molded38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2540002004MODEL                                                                                                                                                                                                                                                                                                                
L2550001003ADDITION  TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, HIGH ROLL CUFF              Thigh/wght bear high roll cu38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2570001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE TWO         Hip clevis type 2 posit jnt 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2570002004POSITION JOINT, EACH                                                                                                                                                                                                                                                                                                 
L2580001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PELVIC SLING                       Pelvic control pelvic sling 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2600001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS TYPE, OR THRUST  Hip clevis/thrust bearing fr38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2600002004BEARING, FREE, EACH                                                                                                                                                                                                                                                                                                  
L2610001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, CLEVIS OR THRUST        Hip clevis/thrust bearing lo38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2610002004BEARING, LOCK, EACH                                                                                                                                                                                                                                                                                                  
L2620001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, HEAVY DUTY, EACH        Pelvic control hip heavy dut38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2622001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION, EACHHip joint adjustable flexion38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2624001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, HIP JOINT, ADJUSTABLE FLEXION,     Hip adj flex ext abduct cont38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2624002004EXTENSION, ABDUCTION CONTROL, EACH                                                                                                                                                                                                                                                                                   
L2627001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PLASTIC, MOLDED TO PATIENT MODEL,  Plastic mold recipro hip & c38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L2627002004RECIPROCATING HIP JOINT AND CABLES                                                                                                                                                                                                                                                                                   
L2628001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, METAL FRAME, RECIPROCATING HIP     Metal frame recipro hip & ca38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L2628002004JOINT AND CABLES                                                                                                                                                                                                                                                                                                     
L2630001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, UNILATERAL          Pelvic control band & belt u38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2640001003ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, BAND AND BELT, BILATERAL           Pelvic control band & belt b38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2650001003ADDITION TO LOWER EXTREMITY, PELVIC AND THORACIC CONTROL, GLUTEAL PAD, EACH     Pelv & thor control gluteal 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2660001003ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, THORACIC BAND                    Thoracic control thoracic ba38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2670001003ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, PARASPINAL UPRIGHTS              Thorac cont paraspinal uprig38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2680001003ADDITION TO LOWER EXTREMITY, THORACIC CONTROL, LATERAL SUPPORT UPRIGHTS         Thorac cont lat support upri38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2750001003ADDITION TO LOWER EXTREMITY ORTHOSIS, PLATING CHROME OR NICKEL, PER BAR         Plating chrome/nickel pr bar38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2755001003ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH STRENGTH, LIGHTWEIGHT MATERIAL, ALL  Carbon graphite lamination  38      A                                                                                                     C                          D1F P      01997010120050101        N                           
L2755002004HYBRID LAMINATION/PREPREG COMPOSITE, PER SEGMENT, FOR CUSTOM FABRICATED                                                                                                                                                                                                                                              
L2755003004ORTHOSIS ONLY                                                                                                                                                                                                                                                                                                        
L2760001003ADDITION TO LOWER EXTREMITY ORTHOSIS, EXTENSION, PER EXTENSION, PER BAR (FOR    Extension per extension per 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2760002004LINEAL ADJUSTMENT FOR GROWTH)                                                                                                                                                                                                                                                                                        
L2768001003ORTHOTIC SIDE BAR DISCONNECT DEVICE, PER BAR                                    Ortho sidebar disconnect    38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L2770001003ADDITION TO LOWER EXTREMITY ORTHOSIS, ANY MATERIAL - PER BAR OR JOINT           Low ext orthosis per bar/jnt38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2780001003ADDITION TO LOWER EXTREMITY ORTHOSIS, NON-CORROSIVE FINISH, PER BAR             Non-corrosive finish        38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L2785001003ADDITION TO LOWER EXTREMITY ORTHOSIS, DROP LOCK RETAINER, EACH                  Drop lock retainer each     38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2795001003ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, FULL KNEECAP                Knee control full kneecap   38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2800001003ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, KNEE CAP, MEDIAL OR LATERAL Knee cap medial or lateral p38      A                                                                                                     C                          D1F P      01988010120050101        N                           
L2800002004PULL, FOR USE WITH CUSTOM FABRICATED ORTHOSIS ONLY                                                                                                                                                                                                                                                                   
L2810001003ADDITION TO LOWER EXTREMITY ORTHOSIS, KNEE CONTROL, CONDYLAR PAD                Knee control condylar pad   38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2820001003ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, BELOW  Soft interface below knee se38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2820002004KNEE SECTION                                                                                                                                                                                                                                                                                                         
L2830001003ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC, ABOVE  Soft interface above knee se38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L2830002004KNEE SECTION                                                                                                                                                                                                                                                                                                         
L2840001003ADDITION TO LOWER EXTREMITY ORTHOSIS, TIBIAL LENGTH SOCK, FRACTURE OR EQUAL,    Tibial length sock fx or equ38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L2840002004EACH                                                                                                                                                                                                                                                                                                                 
L2850001003ADDITION TO LOWER EXTREMITY ORTHOSIS, FEMORAL LENGTH SOCK, FRACTURE OR EQUAL,   Femoral lgth sock fx or equa38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L2850002004EACH                                                                                                                                                                                                                                                                                                                 
L2860001003ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION Torsion mechanism knee/ankle00      9                                                                                                     C                          D1F P      01995010119980312        N                           
L2860002004STYLE MECHANISM, EACH                                                                                                                                                                                                                                                                                                
L2999001003LOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED                               Lower extremity orthosis NOS46      A                                                                                                     C                          D1F P      01982010119980101        N                           
L3000001003FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, 'UCB' TYPE, BERKELEY SHELL,   Ft insert ucb berkeley shell00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3000002004EACH                                                                                                                                                                                                                                                                                                                 
L3001001003FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SPENCO, EACH                  Foot insert remov molded spe00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3002001003FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, PLASTAZOTE OR EQUAL, EACH     Foot insert plastazote or eq00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3003001003FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SILICONE GEL, EACH            Foot insert silicone gel eac00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3010001003FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL ARCH SUPPORT,    Foot longitudinal arch suppo00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3010002004EACH                                                                                                                                                                                                                                                                                                                 
L3020001003FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL/ METATARSAL      Foot longitud/metatarsal sup00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3020002004SUPPORT, EACH                                                                                                                                                                                                                                                                                                        
L3030001003FOOT, INSERT, REMOVABLE, FORMED TO PATIENT FOOT, EACH                           Foot arch support remov prem00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3031001003FOOT, INSERT/PLATE, REMOVABLE, ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH       Foot lamin/prepreg composite00      9                                                                                                     C                          D1F P      02004010120050101        F                           
L3031002004STRENGTH, LIGHTWEIGHT MATERIAL, ALL HYBRID LAMINATION/PREPREG COMPOSITE, EACH                                                                                                                                                                                                                                        
L3040001003FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL, EACH                    Ft arch suprt premold longit00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3050001003FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, METATARSAL, EACH                      Foot arch supp premold metat00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3060001003FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL/ METATARSAL, EACH        Foot arch supp longitud/meta00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3070001003FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL, EACH          Arch suprt att to sho longit00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3080001003FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, METATARSAL, EACH            Arch supp att to shoe metata00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3090001003FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL/METATARSAL,    Arch supp att to shoe long/m00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3090002004EACH                                                                                                                                                                                                                                                                                                                 
L3100001003HALLUS-VALGUS NIGHT DYNAMIC SPLINT                                              Hallus-valgus nght dynamic s00      9                  2323                                                                               D                          D1F P      01985010119970101        N                           
L3140001003FOOT, ABDUCTION ROTATION BAR, INCLUDING SHOES                                   Abduction rotation bar shoe 00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3150001003FOOT, ABDUCTION ROTATATION BAR, WITHOUT SHOES                                   Abduct rotation bar w/o shoe00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3160001003FOOT, ADJUSTABLE SHOE-STYLED POSITIONING DEVICE                                 Shoe styled positioning dev 00      9                                                                                                     C                          D1F P      01986010119950101        N                           
L3170001003FOOT, PLASTIC, SILICONE OR EQUAL,  HEEL STABILIZER, EACH                        Foot plastic heel stabilizer00      9                  2323                                                                               D                          D1F P      01984010120060101        C                           
L3201001003ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, INFANT                      Oxford w supinat/pronat inf 00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3202001003ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, CHILD                       Oxford w/ supinat/pronator c00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3203001003ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, JUNIOR                      Oxford w/ supinator/pronator00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3204001003ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, INFANT                     Hightop w/ supp/pronator inf00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3206001003ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, CHILD                      Hightop w/ supp/pronator chi00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3207001003ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, JUNIOR                     Hightop w/ supp/pronator jun00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3208001003SURGICAL BOOT, EACH, INFANT                                                     Surgical boot each infant   00      9                  2079                                                                               D                          D1F P      01984010119960101        N                           
L3209001003SURGICAL BOOT, EACH, CHILD                                                      Surgical boot each child    00      9                  2079                                                                               D                          D1F P      01984010119960101        N                           
L3211001003SURGICAL BOOT, EACH, JUNIOR                                                     Surgical boot each junior   00      9                  2079                                                                               D                          D1F P      01984010119960101        N                           
L3212001003BENESCH BOOT, PAIR, INFANT                                                      Benesch boot pair infant    00      9                  2079                                                                               D                          D1F P      01984010119960101        N                           
L3213001003BENESCH BOOT, PAIR, CHILD                                                       Benesch boot pair child     00      9                  2079                                                                               D                          D1F P      01984010119960101        N                           
L3214001003BENESCH BOOT, PAIR, JUNIOR                                                      Benesch boot pair junior    00      9                  2079                                                                               D                          D1F P      01984010119960101        N                           
L3215001003ORTHOPEDIC FOOTWEAR, LADIES SHOE, OXFORD, EACH                                  Orthopedic ftwear ladies oxf00      9                                          1862A8                                                     S                          D1F P      01984010120060101        C                           
L3216001003ORTHOPEDIC FOOTWEAR, LADIES SHOE, DEPTH INLAY, EACH                             Orthoped ladies shoes dpth i00      9                                          1862A8                                                     S                          D1F P      01984010120060101        C                           
L3217001003ORTHOPEDIC FOOTWEAR, LADIES SHOE, HIGHTOP, DEPTH INLAY, EACH                    Ladies shoes hightop depth i00      9                                          1862A8                                                     S                          D1F P      01984010120060101        C                           
L3218001003ORTHOPEDIC FOOTWEAR, LADIES SURGICAL BOOT, EACH                                 Ladies surgical boot each   00      9                  2323                                                      L3260                    D                          D1F P      0198401012003010120021231N                           
L3219001003ORTHOPEDIC FOOTWEAR, MENS SHOE, OXFORD, EACH                                    Orthopedic mens shoes oxford00      9                                          1862A8                                                     S                          D1F P      01984010120060101        C                           
L3221001003ORTHOPEDIC FOOTWEAR, MENS SHOE, DEPTH INLAY, EACH                               Orthopedic mens shoes dpth i00      9                                          1862A8                                                     S                          D1F P      01984010120060101        C                           
L3222001003ORTHOPEDIC FOOTWEAR, MENS SHOE, HIGHTOP, DEPTH INLAY, EACH                      Mens shoes hightop depth inl00      9                                          1862A8                                                     S                          D1F P      01984010120060101        C                           
L3223001003ORTHOPEDIC FOOTWEAR, MENS SURGICAL BOOT, EACH                                   Mens surgical boot each     00      9                  2323                                                      L3260                    D                          D1F P      0198401012003010120021231N                           
L3224001003ORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE  Woman's shoe oxford brace   38      A                  2323D                                                                              D                          D1F P      01995010119950101        N                           
L3224002004(ORTHOSIS)                                                                                                                                                                                                                                                                                                           
L3225001003ORTHOPEDIC FOOTWEAR, MAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE    Man's shoe oxford brace     38      A                  2323D                                                                              D                          D1F P      01995010119950101        N                           
L3225002004(ORTHOSIS)                                                                                                                                                                                                                                                                                                           
L3230001003ORTHOPEDIC FOOTWEAR, CUSTOM SHOE, DEPTH INLAY, EACH                             Custom shoes depth inlay    00      9                  2323                                                                               D                          D1F P      01984010120060101        C                           
L3250001003ORTHOPEDIC FOOTWEAR, CUSTOM MOLDED SHOE, REMOVABLE INNER MOLD, PROSTHETIC SHOE, Custom mold shoe remov prost00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3250002004EACH                                                                                                                                                                                                                                                                                                                 
L3251001003FOOT, SHOE MOLDED TO PATIENT MODEL, SILICONE SHOE, EACH                         Shoe molded to pt silicone s00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3252001003FOOT, SHOE MOLDED TO PATIENT MODEL, PLASTAZOTE (OR SIMILAR), CUSTOM FABRICATED, Shoe molded plastazote cust 00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3252002004EACH                                                                                                                                                                                                                                                                                                                 
L3253001003FOOT, MOLDED SHOE PLASTAZOTE (OR SIMILAR) CUSTOM FITTED, EACH                   Shoe molded plastazote cust 00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3254001003NON-STANDARD SIZE OR WIDTH                                                      Orth foot non-stndard size/w00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3255001003NON-STANDARD SIZE OR LENGTH                                                     Orth foot non-standard size/00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3257001003ORTHOPEDIC FOOTWEAR, ADDITIONAL CHARGE FOR SPLIT SIZE                           Orth foot add charge split s00      9                  2323                                                                               D                          D1F P      01988010119970101        N                           
L3260001003SURGICAL BOOT/SHOE, EACH                                                        Ambulatory surgical boot eac00      9                  2079                                                                               D                          D1F P      01984010120030101        N                           
L3265001003PLASTAZOTE SANDAL, EACH                                                         Plastazote sandal each      00      9                                                                                                     C                          D1F P      01984010119960101        N                           
L3300001003LIFT, ELEVATION, HEEL, TAPERED TO METATARSALS, PER INCH                         Sho lift taper to metatarsal00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3310001003LIFT, ELEVATION, HEEL AND SOLE, NEOPRENE, PER INCH                              Shoe lift elev heel/sole neo00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3320001003LIFT, ELEVATION, HEEL AND SOLE, CORK, PER INCH                                  Shoe lift elev heel/sole cor00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3330001003LIFT, ELEVATION, METAL EXTENSION (SKATE)                                        Lifts elevation metal extens00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3332001003LIFT, ELEVATION, INSIDE SHOE, TAPERED, UP TO ONE-HALF INCH                      Shoe lifts tapered to one-ha00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3334001003LIFT, ELEVATION, HEEL, PER INCH                                                 Shoe lifts elevation heel /i00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3340001003HEEL WEDGE, SACH                                                                Shoe wedge sach             00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3350001003HEEL WEDGE                                                                      Shoe heel wedge             00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3360001003SOLE WEDGE, OUTSIDE SOLE                                                        Shoe sole wedge outside sole00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3370001003SOLE WEDGE, BETWEEN SOLE                                                        Shoe sole wedge between sole00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3380001003CLUBFOOT WEDGE                                                                  Shoe clubfoot wedge         00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3390001003OUTFLARE WEDGE                                                                  Shoe outflare wedge         00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3400001003METATARSAL BAR WEDGE, ROCKER                                                    Shoe metatarsal bar wedge ro00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3410001003METATARSAL BAR WEDGE, BETWEEN SOLE                                              Shoe metatarsal bar between 00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3420001003FULL SOLE AND HEEL WEDGE, BETWEEN SOLE                                          Full sole/heel wedge btween 00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3430001003HEEL, COUNTER, PLASTIC REINFORCED                                               Sho heel count plast reinfor00      9                  2323                                                                               D                          D1F P      01985010119970101        N                           
L3440001003HEEL, COUNTER, LEATHER REINFORCED                                               Heel leather reinforced     00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3450001003HEEL, SACH CUSHION TYPE                                                         Shoe heel sach cushion type 00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3455001003HEEL, NEW LEATHER, STANDARD                                                     Shoe heel new leather standa00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3460001003HEEL, NEW RUBBER, STANDARD                                                      Shoe heel new rubber standar00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3465001003HEEL, THOMAS WITH WEDGE                                                         Shoe heel thomas with wedge 00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3470001003HEEL, THOMAS EXTENDED TO BALL                                                   Shoe heel thomas extend to b00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3480001003HEEL, PAD AND DEPRESSION FOR SPUR                                               Shoe heel pad & depress for 00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3485001003HEEL, PAD, REMOVABLE FOR SPUR                                                   Shoe heel pad removable for 00      9                  2323                                                                               D                          D1F P      01984010119970101        N                           
L3500001003ORTHOPEDIC SHOE ADDITION, INSOLE, LEATHER                                       Ortho shoe add leather insol00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3510001003ORTHOPEDIC SHOE ADDITION, INSOLE, RUBBER                                        Orthopedic shoe add rub insl00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3520001003ORTHOPEDIC SHOE ADDITION, INSOLE, FELT COVERED WITH LEATHER                     O shoe add felt w leath insl00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3530001003ORTHOPEDIC SHOE ADDITION, SOLE, HALF                                            Ortho shoe add half sole    00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3540001003ORTHOPEDIC SHOE ADDITION, SOLE, FULL                                            Ortho shoe add full sole    00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3550001003ORTHOPEDIC SHOE ADDITION, TOE TAP STANDARD                                      O shoe add standard toe tap 00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3560001003ORTHOPEDIC SHOE ADDITION, TOE TAP, HORSESHOE                                    O shoe add horseshoe toe tap00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3570001003ORTHOPEDIC SHOE ADDITION, SPECIAL EXTENSION TO INSTEP (LEATHER WITH EYELETS)    O shoe add instep extension 00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3580001003ORTHOPEDIC SHOE ADDITION, CONVERT INSTEP TO VELCRO CLOSURE                      O shoe add instep velcro clo00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3590001003ORTHOPEDIC SHOE ADDITION, CONVERT FIRM SHOE COUNTER TO SOFT COUNTER             O shoe convert to sof counte00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3595001003ORTHOPEDIC SHOE ADDITION, MARCH BAR                                             Ortho shoe add march bar    00      9                  2323                                                                               D                          D1F P      01986010119990101        N                           
L3600001003TRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, EXISTING      Trans shoe calip plate exist00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3610001003TRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, NEW           Trans shoe caliper plate new00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3620001003TRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, EXISTING      Trans shoe solid stirrup exi00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3630001003TRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, NEW           Trans shoe solid stirrup new00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3640001003TRANSFER  OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, DENNIS BROWNE SPLINT         Shoe dennis browne splint bo00      9                  2323                                                                               D                          D1F P      01986010119970101        N                           
L3640002004(RIVETON), BOTH SHOES                                                                                                                                                                                                                                                                                                
L3649001003ORTHOPEDIC SHOE, MODIFICATION, ADDITION OR TRANSFER, NOT OTHERWISE SPECIFIED    Orthopedic shoe modifica NOS00      9                  2323                                                                               D                          D1F P      01982010119990101        N                           
L3650001003SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, PREFABRICATED,  Shlder fig 8 abduct restrain38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L3650002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L3651001003SHOULDER ORTHOSIS, SINGLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING    Prefab shoulder orthosis    38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L3651002004AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                
L3652001003SHOULDER ORTHOSIS, DOUBLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING    Prefab dbl shoulder orthosis38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L3652002004AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                
L3660001003SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND      Abduct restrainer canvas&web38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3660002004WEBBING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                              
L3670001003SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, Acromio/clavicular canvas&we38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3670002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L3671001003SHOULDER ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT        SO cap design w/o jnts CF   38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3671002004INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                
L3672001003SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT  SO airplane w/o jnts CF     38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3672002004AND SUPPORT BAR, WITHOUT JOINTS, MAY INLCUDE SOFT INTERFACE, STRAPS, CUSTOM                                                                                                                                                                                                                                          
L3672003004FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L3673001003SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT  SO airplane w/joint CF      38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3673002004AND SUPPORT BAR, INCLUDES NONTORSION JOINT/TURNBUCKLE, MAY INCLUDE SOFT                                                                                                                                                                                                                                              
L3673003004INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                
L3675001003SHOULDER ORTHOSIS, VEST TYPE ABDUCTION RESTRAINER, CANVAS WEBBING TYPE OR       Canvas vest SO              38      A                                                                                                     C                          D1F P      01999010120010101        N                           
L3675002004EQUAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                
L3677001003SHOULDER ORTHOSIS, HARD PLASTIC, SHOULDER STABILIZER, PRE-FABRICATED, INCLUDES  SO hard plastic stabilizer  00      9                  2130                                                                               D                          Z2  P      02002010120020101        N                           
L3677002004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L3700001003ELBOW ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND         Elbow orthoses elas w stays 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3700002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3701001003ELBOW ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G.   Prefab elbow orthosis       38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L3701002004NEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                                     
L3702001003ELBOW ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM      EO w/o joints CF            38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3702002004FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L3710001003ELBOW ORTHOSIS, ELASTIC WITH METAL JOINTS, PREFABRICATED, INCLUDES FITTING AND  Elbow elastic with metal joi38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L3710002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3720001003ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, FREE MOTION,             Forearm/arm cuffs free motio38      A                                                                                                     C                          D1F P      01984010120010101        N                           
L3720002004CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L3730001003ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, EXTENSION/ FLEXION       Forearm/arm cuffs ext/flex a38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3730002004ASSIST, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                            
L3740001003ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, ADJUSTABLE POSITION LOCK Cuffs adj lock w/ active con38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3740002004WITH ACTIVE CONTROL, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                               
L3760001003ELBOW ORTHOSIS, WITH ADJUSTABLE POSITION LOCKING JOINT(S), PREFABRICATED,       EO withjoint, Prefabricated 38      A                                                                                                     C                          D1F P      02001010120010101        N                           
L3760002004INCLUDES FITTING AND ADJUSTMENTS, ANY TYPE                                                                                                                                                                                                                                                                           
L3762001003ELBOW ORTHOSIS, RIGID, WITHOUT JOINTS, INCLUDES SOFT INTERFACE MATERIAL,        Rigid EO wo joints          38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L3762002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3763001003ELBOW WRIST HAND ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE,   EWHO rigid w/o jnts CF      38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3763002004STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L3764001003ELBOW WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC      EWHO w/joint(s) CF          38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3764002004BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED,                                                                                                                                                                                                                                           
L3764003004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L3765001003ELBOW WRIST HAND FINGER ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT       EWHFO rigid w/o jnts CF     38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3765002004INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                
L3766001003ELBOW WRIST HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS,       EWHFO w/joint(s) CF         38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3766002004ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                                                                                                                                                                                                                                               
L3766003004FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L3800001003WRIST HAND FINGER ORTHOSIS, SHORT OPPONENS, NO ATTACHMENTS, CUSTOM-FABRICATED   Whfo short opponen no attach38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3805001003WRIST HAND FINGER ORTHOSIS, LONG OPPONENS, NO ATTACHMENT, CUSTOM-FABRICATED     Whfo long opponens no attach38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3807001003WRIST HAND FINGER ORTHOSIS, WITHOUT JOINT(S), PREFABRICATED, INCLUDES FITTING   WHFO,no joint, prefabricated38      A                                                                                                     C                          D1F P      02000010120010101        N                           
L3807002004AND ADJUSTMENTS, ANY TYPE                                                                                                                                                                                                                                                                                            
L3810001003WHFO, ADDITION  TO SHORT AND LONG OPPONENS, THUMB ABDUCTION ('C') BAR           Whfo thumb abduction bar    38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3815001003WHFO, ADDITION  TO SHORT AND LONG OPPONENS, SECOND M.P. ABDUCTION ASSIST        Whfo second m.p. abduction a38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3820001003WHFO, 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      01986010119960101        N                           
L3820002004EXTENSION STOP                                                                                                                                                                                                                                                                                                       
L3825001003WHFO, ADDITION  TO SHORT AND LONG OPPONENS, M.P. EXTENSION STOP                 Whfo m.p. extension stop    38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3830001003WHFO, ADDITION  TO SHORT AND LONG OPPONENS, M.P. EXTENSION ASSIST               Whfo m.p. extension assist  38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3835001003WHFO, ADDITION  TO SHORT AND LONG OPPONENS, M.P. SPRING EXTENSION ASSIST        Whfo m.p. spring extension a38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3840001003WHFO, ADDITION  TO SHORT AND LONG OPPONENS, SPRING SWIVEL THUMB                 Whfo spring swivel thumb    38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3845001003WHFO, ADDITION  TO SHORT AND LONG OPPONENS, THUMB I.P. EXTENSION ASSIST, WITH   Whfo thumb ip ext ass w/ mp 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3845002004M.P. STOP                                                                                                                                                                                                                                                                                                            
L3850001003WHO, ADDITION TO SHORT AND LONG OPPONENS, ACTION WRIST, WITH DORSIFLEXION ASSISTAction wrist w/ dorsiflex as38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3855001003WHFO, ADDITION  TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL     Whfo adj m.p. flexion contro38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3860001003WHFO, ADDITION  TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL AND Whfo adj m.p. flex ctrl & i.38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L3860002004I.P.                                                                                                                                                                                                                                                                                                                 
L3890001003ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE        Torsion mechanism wrist/elbo00      9                                                                                                     C                          D1F P      01995010119980312        N                           
L3890002004TORSION STYLE MECHANISM, EACH                                                                                                                                                                                                                                                                                        
L3900001003WRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/   Hinge extension/flex wrist/f38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L3900002004FLEXION, FINGER FLEXION/EXTENSION, WRIST OR FINGER DRIVEN, CUSTOM-FABRICATED                                                                                                                                                                                                                                         
L3901001003WRIST HAND FINGER ORTHOSIS, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/   Hinge ext/flex wrist finger 38      A                                                                                                     C                          D1F P      01984010120010101        N                           
L3901002004FLEXION, FINGER FLEXION/EXTENSION, CABLE DRIVEN, CUSTOM-FABRICATED                                                                                                                                                                                                                                                   
L3902001003WRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, COMPRESSED GAS, CUSTOM-FABRICATED Whfo ext power compress gas 00      9                                                                                                     I                          D1F P      01985010120040101        N                           
L3904001003WRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, ELECTRIC, CUSTOM-FABRICATED       Whfo electric custom fitted 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3905001003WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS,     WHO w/nontorsion jnt(s) CF  38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3905002004TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES                                                                                                                                                                                                                                         
L3905003004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L3906001003WRIST HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM WHO w/o joints CF           38      A                                                                                                     C                          D1F P      01986010120060101        C                           
L3906002004FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L3907001003WRIST HAND FINGER ORTHOSIS, WRIST GAUNTLET WITH THUMB SPICA, CUSTOM-FABRICATED  Whfo wrst gauntlt thmb spica38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L3908001003WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED,               Wrist cock-up non-molded    38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L3908002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3909001003WRIST ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G.   Prefab wrist orthosis       38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L3909002004NEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                                     
L3910001003WRIST HAND FINGER ORTHOSIS, SWANSON DESIGN, PREFABRICATED, INCLUDES FITTING AND Whfo swanson design         38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3910002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3911001003WRIST HAND FINGER ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND        Prefab hand finger orthosis 38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L3911002004ADJUSTMENT (E.G. NEOPRENE, LYCRA)                                                                                                                                                                                                                                                                                    
L3912001003HAND FINGER ORTHOSIS, FLEXION GLOVE WITH ELASTIC FINGER CONTROL, PREFABRICATED, Flex glove w/elastic finger 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3912002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L3913001003HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS,       HFO w/o joints CF           38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3913002004CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                   
L3914001003WRIST HAND ORTHOSIS, WRIST EXTENSION COCK-UP, PREFABRICATED, INCLUDES           WHO wrist extension cock-up 38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L3914002004FITTING/ADJUSTMENT                                                                                                                                                                                                                                                                                                   
L3916001003WRIST HAND FINGER ORTHOSIS, WRIST EXTENSION COCK-UP WITH OUTRIGGER,             Whfo wrist extens w/ outrigg38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L3916002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3917001003HAND ORTHOSIS, METACARPAL FRACTURE ORTHOSIS, PREFABRICATED, INCLUDES FITTING    Prefab metacarpl fx orthosis38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L3917002004AND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L3918001003HAND FINGER ORTHOSIS, KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND       HFO knuckle bender          38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3918002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3919001003HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM       HO w/o joints CF            38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3919002004FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L3920001003HAND FINGER ORTHOSIS, KNUCKLE BENDER WITH OUTRIGGER, PREFABRICATED, INCLUDES    Knuckle bender with outrigge38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3920002004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L3921001003HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS,    HFO w/joint(s) CF           38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3921002004TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES                                                                                                                                                                                                                                         
L3921003004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L3922001003HAND FINGER ORTHOSIS, KNUCKLE BENDER, TWO SEGMENT TO FLEX JOINTS,               Knuckle bend 2 seg to flex j38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3922002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3923001003HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS,       HFO w/o joints PF           38      A                                                                                                     C                          D1F P      02001010120060101        C                           
L3923002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3924001003WRIST HAND FINGER ORTHOSIS, OPPENHEIMER, PREFABRICATED, INCLUDES FITTING AND    Oppenheimer                 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3924002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3926001003WRIST HAND FINGER ORTHOSIS, THOMAS SUSPENSION, PREFABRICATED, INCLUDES FITTING  Thomas suspension           38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3926002004AND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L3928001003HAND FINGER ORTHOSIS, FINGER EXTENSION, WITH CLOCK SPRING, PREFABRICATED,       Finger extension w/ clock sp38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3928002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L3930001003WRIST HAND FINGER ORTHOSIS, FINGER EXTENSION, WITH WRIST SUPPORT,               Finger extension with wrist 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3930002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3932001003FINGER ORTHOSIS, SAFETY PIN, SPRING WIRE, PREFABRICATED, INCLUDES FITTING AND   Safety pin spring wire      38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3932002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3933001003FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED, FO w/o joints CF            38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3933002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L3934001003FINGER ORTHOSIS, SAFETY PIN, MODIFIED, PREFABRICATED, INCLUDES FITTING AND      Safety pin modified         38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3934002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3935001003FINGER ORTHOSIS, NONTORSION JOINT, MAY INCLUDE SOFT INTERFACE, CUSTOM           FO nontorsion joint CF      38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3935002004FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L3936001003WRIST HAND FINGER ORTHOSIS, PALMER, PREFABRICATED, INCLUDES FITTING AND         Palmer                      38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3936002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3938001003WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, PREFABRICATED, INCLUDES FITTING AND   Dorsal wrist                38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3938002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3940001003WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, WITH OUTRIGGER ATTACHMENT,            Dorsal wrist w/ outrigger at38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3940002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3942001003HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING   Reverse knuckle bender      38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3942002004AND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L3944001003HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, WITH OUTRIGGER, PREFABRICATED,    Reverse knuckle bend w/ outr38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3944002004INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                      
L3946001003HAND FINGER ORTHOSIS, COMPOSITE ELASTIC, PREFABRICATED, INCLUDES FITTING AND    HFO composite elastic       38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3946002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3948001003FINGER ORTHOSIS, FINGER KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND     Finger knuckle bender       38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3948002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3950001003WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH KNUCKLE BENDER AND    Oppenheimer w/ knuckle bend 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3950002004TWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                      
L3952001003WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH REVERSE KNUCKLE AND   Oppenheimer w/ rev knuckle 238      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3952002004TWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                      
L3954001003HAND FINGER ORTHOSIS, SPREADING HAND, PREFABRICATED, INCLUDES FITTING AND       Spreading hand              38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3954002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3956001003ADDITION OF JOINT TO UPPER EXTREMITY ORTHOSIS, ANY MATERIAL; PER JOINT          Add joint upper ext orthosis38      A                                                                                                     C                          D1F P      01997010119970101        N                           
L3960001003SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, AIRPLANE DESIGN,     Sewho airplan desig abdu pos38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L3960002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3961001003SHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY    SEWHO cap design w/o jnts CF38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3961002004INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                              
L3961003004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3962001003SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING, ERBS PALSEY DESIGN,  Sewho erbs palsey design abd38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3962002004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3963001003SHOULDER ELBOW WRIST HAND ORTHOSIS, MOLDED SHOULDER, ARM, FOREARM AND WRIST,    Molded w/ articulating elbow38      A                                                                                                     C                          D1F P      0198801012006010120051231D                           
L3963002004WITH ARTICULATING  ELBOW JOINT, CUSTOM-FABRICATED                                                                                                                                                                                                                                                                    
L3964001003SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED,   Seo mobile arm sup att to wc32      A                                                                                                     C                          D1D APR    01986010120010101        N                           
L3964002004ADJUSTABLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L3965001003SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED,   Arm supp att to wc rancho ty32      A                                                                                                     C                          D1D APR    01984010120010101        N                           
L3965002004ADJUSTABLE RANCHO TYPE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                               
L3966001003SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED,   Mobile arm supports reclinin32      A                                                                                                     C                          D1D APR    01986010120010101        N                           
L3966002004RECLINING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                            
L3967001003SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN),    SEWHO airplane w/o jnts CF  38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3967002004THORACIC COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE,                                                                                                                                                                                                                                      
L3967003004STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L3968001003SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED,   Friction dampening arm supp 32      A                                                                                                     C                          D1D APR    01986010120010101        N                           
L3968002004FRICTION ARM SUPPORT (FRICTION DAMPENING TO PROXIMAL AND DISTAL JOINTS),                                                                                                                                                                                                                                             
L3968003004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L3969001003SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT, MONOSUSPENSION ARM AND HAND        Monosuspension arm/hand supp32      A                                                                                                     C                          D1D APR    01988010120010101        N                           
L3969002004SUPPORT, OVERHEAD ELBOW FOREARM HAND SLING SUPPORT, YOKE TYPE SUSPENSION                                                                                                                                                                                                                                             
L3969003004SUPPORT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                              
L3970001003SEO, ADDITION TO MOBILE ARM SUPPORT, ELEVATING PROXIMAL ARM                     Elevat proximal arm support 32      A                                                                                                     C                          D1D APR    01986010119980101        N                           
L3971001003SHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE OR MORE   SEWHO cap design w/jnt(s) CF38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3971002004NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE,                                                                                                                                                                                                                                           
L3971003004STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L3972001003SEO, ADDITION TO MOBILE ARM SUPPORT, OFFSET OR LATERAL ROCKER ARM WITH ELASTIC  Offset/lat rocker arm w/ ela32      A                                                                                                     C                          D1D APR    01986010119980101        N                           
L3972002004BALANCE CONTROL                                                                                                                                                                                                                                                                                                      
L3973001003SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN),    SEWHO airplane w/jnt(s) CF  38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3973002004THORACIC COMPONENT AND SUPPORT BAR, INCLUDES ONE OR MORE NONTORSION JOINTS,                                                                                                                                                                                                                                          
L3973003004ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                                                                                                                                                                                                                                               
L3973004004FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L3974001003SEO, ADDITION TO MOBILE ARM SUPPORT, SUPINATOR                                  Mobile arm support supinator32      A                                                                                                     C                          D1D APR    01986010119980101        N                           
L3975001003SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, SEWHFO cap design w/o jnt CF38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3975002004MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND                                                                                                                                                                                                                                          
L3975003004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3976001003SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE      SEWHFO airplane w/o jnts CF 38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3976002004DESIGN), THORACIC COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INCLUDE SOFT                                                                                                                                                                                                                                        
L3976003004INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                
L3977001003SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE OR SEWHFO cap desgn w/jnt(s) CF38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3977002004MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE,                                                                                                                                                                                                                                      
L3977003004STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                           
L3978001003SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE      SEWHFO airplane w/jnt(s) CF 38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L3978002004DESIGN), THORACIC COMPONENT AND SUPPORT BAR, INCLUDES ONE OR MORE NONTORSION                                                                                                                                                                                                                                         
L3978003004JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM                                                                                                                                                                                                                                       
L3978004004FABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                          
L3980001003UPPER EXTREMITY FRACTURE ORTHOSIS, HUMERAL, PREFABRICATED, INCLUDES FITTING AND Upp ext fx orthosis humeral 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3980002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3982001003UPPER EXTREMITY FRACTURE ORTHOSIS, RADIUS/ULNAR, PREFABRICATED, INCLUDES        Upper ext fx orthosis rad/ul38      A                                                                                                     C                          D1F P      01984010120010101        N                           
L3982002004FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                                               
L3984001003UPPER EXTREMITY FRACTURE ORTHOSIS, WRIST, PREFABRICATED, INCLUDES FITTING AND   Upper ext fx orthosis wrist 38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3984002004ADJUSTMENT                                                                                                                                                                                                                                                                                                           
L3985001003UPPER EXTREMITY FRACTURE ORTHOSIS, FOREARM, HAND WITH WRIST HINGE,              Forearm hand fx orth w/ wr h38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L3985002004CUSTOM-FABRICATED                                                                                                                                                                                                                                                                                                    
L3986001003UPPER EXTREMITY FRACTURE ORTHOSIS, COMBINATION OF HUMERAL, RADIUS/ULNAR, WRIST, Humeral rad/ulna wrist fx or38      A                                                                                                     C                          D1F P      01984010120010101        N                           
L3986002004(EXAMPLE--COLLES' FRACTURE), CUSTOM FABRICATED                                                                                                                                                                                                                                                                       
L3995001003ADDITION TO UPPER EXTREMITY ORTHOSIS, SOCK, FRACTURE OR EQUAL, EACH             Sock fracture or equal each 38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L3999001003UPPER LIMB ORTHOSIS, NOT OTHERWISE SPECIFIED                                    Upper limb orthosis NOS     46      A                                                                                                     C                          D1F P      01982010119980101        N                           
L4000001003REPLACE GIRDLE FOR SPINAL ORTHOSIS (CTLSO OR SO)                                Repl girdle milwaukee orth  38      A                                                                                                     C                          D1F P      01985010120020101        N                           
L4002001003REPLACEMENT STRAP, ANY ORTHOSIS, INCLUDES ALL COMPONENTS, ANY LENGTH, ANY TYPE  Replace strap, any orthosis 38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L4010001003REPLACE TRILATERAL SOCKET BRIM                                                  Replace trilateral socket br38      A                                                                                                     C                          D1F P      01985010119960101        N                           
L4020001003REPLACE QUADRILATERAL SOCKET BRIM, MOLDED TO PATIENT MODEL                      Replace quadlat socket brim 38      A                                                                                                     C                          D1F P      01985010119960101        N                           
L4030001003REPLACE QUADRILATERAL SOCKET BRIM, CUSTOM FITTED                                Replace socket brim cust fit38      A                                                                                                     C                          D1F P      01985010119960101        N                           
L4040001003REPLACE MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY                 Replace molded thigh lacer  38      A                                                                                                     C                          D1F P      01985010120050101        N                           
L4045001003REPLACE NON-MOLDED THIGH LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY             Replace non-molded thigh lac38      A                                                                                                     C                          D1F P      01988010120050101        N                           
L4050001003REPLACE MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY                  Replace molded calf lacer   38      A                                                                                                     C                          D1F P      01985010120050101        N                           
L4055001003REPLACE NON-MOLDED CALF LACER, FOR CUSTOM FABRICATED ORTHOSIS ONLY              Replace non-molded calf lace38      A                                                                                                     C                          D1F P      01988010120050101        N                           
L4060001003REPLACE HIGH ROLL CUFF                                                          Replace high roll cuff      38      A                                                                                                     C                          D1F P      01985010119960101        N                           
L4070001003REPLACE PROXIMAL AND DISTAL UPRIGHT FOR KAFO                                    Replace prox & dist upright 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L4080001003REPLACE METAL BANDS KAFO, PROXIMAL THIGH                                        Repl met band kafo-afo prox 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L4090001003REPLACE METAL BANDS KAFO-AFO, CALF OR DISTAL THIGH                              Repl met band kafo-afo calf/38      A                                                                                                     C                          D1F P      01985010119960101        N                           
L4100001003REPLACE LEATHER CUFF KAFO, PROXIMAL THIGH                                       Repl leath cuff kafo prox th38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L4110001003REPLACE LEATHER CUFF KAFO-AFO, CALF OR DISTAL THIGH                             Repl leath cuff kafo-afo cal38      A                                                                                                     C                          D1F P      01985010119960101        N                           
L4130001003REPLACE PRETIBIAL SHELL                                                         Replace pretibial shell     38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L4205001003REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES                      Ortho dvc repair per 15 min 46      A                  2100.4                                                                             D                          D1F P      01997010119970101        N                           
L4210001003REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS                        Orth dev repair/repl minor p46      A                  2133    2100.4  2130D                                                              D                          D1F P      01985010119960101        N                           
L4350001003ANKLE CONTROL ORTHOSIS, STIRRUP STYLE, RIGID, INCLUDES ANY TYPE INTERFACE       Ankle control orthosi prefab38      A                                                                                                     C                          D1F P      01989010120040101        N                           
L4350002004(E.G., PNEUMATIC, GEL),  PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                              
L4360001003WALKING BOOT, PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE      Pneumati walking boot prefab38      A                                                                                                     C                          D1F P      01989010120040101        N                           
L4360002004MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                             
L4370001003PNEUMATIC FULL LEG SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT       Pneumatic full leg splint   38      A                                                                                                     C                          D1F P      01989010120030101        N                           
L4380001003PNEUMATIC KNEE SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT           Pneumatic knee splint       38      A                                                                                                     C                          D1F P      01989010120030101        N                           
L4386001003WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE  Non-pneum walk boot prefab  38      A                                                                                                     C                          D1F P      02003010120040101        N                           
L4386002004MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                             
L4392001003REPLACEMENT, SOFT INTERFACE MATERIAL, STATIC AFO                                Replace AFO soft interface  38      A                                                                                                     C                          D1F P      01997010120010101        N                           
L4394001003REPLACE SOFT INTERFACE MATERIAL, FOOT DROP SPLINT                               Replace foot drop spint     38      A                                                                                                     C                          D1F P      01997010119970101        N                           
L4396001003STATIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL,  ADJUSTABLE FOR  Static AFO                  38      A                                                                                                     C                          D1F P      01997010120020101        N                           
L4396002004FIT, FOR  POSITIONING, PRESSURE REDUCTION, MAY BE USED FOR MINIMAL AMBULATION,                                                                                                                                                                                                                                       
L4396003004PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                                       
L4398001003FOOT DROP SPLINT, RECUMBENT POSITIONING DEVICE, PREFABRICATED, INCLUDES FITTING Foot drop splint recumbent  38      A                                                                                                     C                          D1F P      01997010120010101        N                           
L4398002004AND ADJUSTMENT                                                                                                                                                                                                                                                                                                       
L5000001003PARTIAL FOOT, SHOE INSERT WITH LONGITUDINAL ARCH, TOE FILLER                    Sho insert w arch toe filler38      A                  2323                                                                               D                          D1F P      01982010119960101        N                           
L5010001003PARTIAL FOOT, MOLDED SOCKET, ANKLE HEIGHT, WITH TOE FILLER                      Mold socket ank hgt w/ toe f38      A                  2323                                                                               D                          D1F P      01982010119960101        N                           
L5020001003PARTIAL FOOT, MOLDED SOCKET, TIBIAL TUBERCLE HEIGHT, WITH TOE FILLER            Tibial tubercle hgt w/ toe f38      A                  2323                                                                               D                          D1F P      01982010119960101        N                           
L5050001003ANKLE, SYMES, MOLDED SOCKET, SACH FOOT                                          Ank symes mold sckt sach ft 38      A                                                                                                     C                          D1F P      01985010119960101        N                           
L5060001003ANKLE, SYMES, METAL FRAME, MOLDED LEATHER SOCKET, ARTICULATED ANKLE/FOOT        Symes met fr leath socket ar38      A                                                                                                     C                          D1F P      01985010119960101        N                           
L5100001003BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT                                      Molded socket shin sach foot38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5105001003BELOW KNEE, PLASTIC SOCKET, JOINTS AND THIGH LACER, SACH FOOT                   Plast socket jts/thgh lacer 38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5150001003KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS,    Mold sckt ext knee shin sach38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5150002004SHIN, SACH FOOT                                                                                                                                                                                                                                                                                                      
L5160001003KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, BENT KNEE CONFIGURATION, Mold socket bent knee shin s38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5160002004EXTERNAL KNEE JOINTS, SHIN, SACH FOOT                                                                                                                                                                                                                                                                                
L5200001003ABOVE KNEE, MOLDED SOCKET, SINGLE AXIS CONSTANT FRICTION KNEE, SHIN, SACH FOOT  Kne sing axis fric shin sach38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5210001003ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH FOOT BLOCKS, NO  No knee/ankle joints w/ ft b38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5210002004ANKLE JOINTS, EACH                                                                                                                                                                                                                                                                                                   
L5220001003ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH ARTICULATED      No knee joint with artic ali38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5220002004ANKLE/FOOT, DYNAMICALLY ALIGNED, EACH                                                                                                                                                                                                                                                                                
L5230001003ABOVE KNEE, FOR PROXIMAL FEMORAL FOCAL DEFICIENCY, CONSTANT FRICTION KNEE,      Fem focal defic constant fri38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5230002004SHIN, SACH FOOT                                                                                                                                                                                                                                                                                                      
L5250001003HIP DISARTICULATION, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS       Hip canad sing axi cons fric38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5250002004CONSTANT FRICTION KNEE, SHIN, SACH FOOT                                                                                                                                                                                                                                                                              
L5270001003HIP DISARTICULATION, TILT TABLE TYPE; MOLDED SOCKET, LOCKING HIP JOINT, SINGLE  Tilt table locking hip sing 38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5270002004AXIS CONSTANT FRICTION KNEE, SHIN, SACH FOOT                                                                                                                                                                                                                                                                         
L5280001003HEMIPELVECTOMY, CANADIAN TYPE; MOLDED SOCKET, HIP JOINT, SINGLE AXIS CONSTANT   Hemipelvect canad sing axis 38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5280002004FRICTION KNEE, SHIN, SACH FOOT                                                                                                                                                                                                                                                                                       
L5301001003BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT, ENDOSKELETAL SYSTEM                 BK mold socket SACH ft endo 38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L5311001003KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, EXTERNAL KNEE JOINTS,    Knee disart, SACH ft, endo  38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L5311002004SHIN, SACH FOOT, ENDOSKELETAL SYSTEM                                                                                                                                                                                                                                                                                 
L5321001003ABOVE KNEE, MOLDED SOCKET, OPEN END, SACH FOOT, ENDOSKELETAL SYSTEM, SINGLE     AK open end SACH            38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L5321002004AXIS KNEE                                                                                                                                                                                                                                                                                                            
L5331001003HIP DISARTICULATION, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP     Hip disart canadian SACH ft 38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L5331002004JOINT, SINGLE AXIS KNEE, SACH FOOT                                                                                                                                                                                                                                                                                   
L5341001003HEMIPELVECTOMY, CANADIAN TYPE, MOLDED SOCKET, ENDOSKELETAL SYSTEM, HIP JOINT,   Hemipelvectomy canadian SACH38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L5341002004SINGLE AXIS KNEE, SACH FOOT                                                                                                                                                                                                                                                                                          
L5400001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dress & 1 cast chg bk38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5400002004DRESSING, INCLUDING FITTING, ALIGNMENT, SUSPENSION, AND ONE CAST CHANGE, BELOW                                                                                                                                                                                                                                       
L5400003004KNEE                                                                                                                                                                                                                                                                                                                 
L5410001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dsg bk ea add cast ch38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5410002004DRESSING, INCLUDING FITTING, ALIGNMENT AND SUSPENSION, BELOW KNEE, EACH                                                                                                                                                                                                                                              
L5410003004ADDITIONAL CAST CHANGE AND REALIGNMENT                                                                                                                                                                                                                                                                               
L5420001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dsg & 1 cast chg ak/d38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5420002004DRESSING, INCLUDING FITTING, ALIGNMENT AND SUSPENSION AND ONE CAST CHANGE 'AK'                                                                                                                                                                                                                                       
L5420003004OR KNEE DISARTICULATION                                                                                                                                                                                                                                                                                              
L5430001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dsg ak ea add cast ch38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5430002004DRESSING, INCL. FITTING, ALIGNMENT AND SUPENSION, 'AK' OR KNEE DISARTICULATION,                                                                                                                                                                                                                                      
L5430003004EACH ADDITIONAL CAST CHANGE AND REALIGNMENT                                                                                                                                                                                                                                                                          
L5450001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING     Postop app non-wgt bear dsg 38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5450002004RIGID DRESSING, BELOW KNEE                                                                                                                                                                                                                                                                                           
L5460001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING     Postop app non-wgt bear dsg 38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L5460002004RIGID DRESSING, ABOVE KNEE                                                                                                                                                                                                                                                                                           
L5500001003INITIAL, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO COVER,   Init bk ptb plaster direct  38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5500002004SACH FOOT, PLASTER SOCKET, DIRECT FORMED                                                                                                                                                                                                                                                                             
L5505001003INITIAL, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET, NON-ALIGNABLE Init ak ischal plstr direct 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5505002004SYSTEM, PYLON, NO COVER, SACH FOOT, PLASTER SOCKET, DIRECT FORMED                                                                                                                                                                                                                                                    
L5510001003PREPARATORY, BELOW KNEE  'PTB'  TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO    Prep BK ptb plaster molded  38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5510002004COVER, SACH FOOT, PLASTER SOCKET, MOLDED TO MODEL                                                                                                                                                                                                                                                                    
L5520001003PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO      Perp BK ptb thermopls direct38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5520002004COVER, SACH FOOT, THERMOPLASTIC OR EQUAL, DIRECT FORMED                                                                                                                                                                                                                                                              
L5530001003PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO      Prep BK ptb thermopls molded38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5530002004COVER, SACH FOOT, THERMOPLASTIC OR EQUAL, MOLDED TO MODEL                                                                                                                                                                                                                                                            
L5535001003PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, NO COVER, SACH Prep BK ptb open end socket 38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5535002004FOOT, PREFABRICATED, ADJUSTABLE OPEN END SOCKET                                                                                                                                                                                                                                                                      
L5540001003PREPARATORY, BELOW KNEE 'PTB' TYPE SOCKET, NON-ALIGNABLE SYSTEM, PYLON, NO      Prep BK ptb laminated socket38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5540002004COVER, SACH FOOT, LAMINATED SOCKET, MOLDED TO MODEL                                                                                                                                                                                                                                                                  
L5560001003PREPARATORY, ABOVE KNEE- KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET,            Prep AK ischial plast molded38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5560002004NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, PLASTER SOCKET, MOLDED TO                                                                                                                                                                                                                                          
L5560003004MODEL                                                                                                                                                                                                                                                                                                                
L5570001003PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET,           Prep AK ischial direct form 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5570002004NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, THERMOPLASTIC OR EQUAL,                                                                                                                                                                                                                                            
L5570003004DIRECT FORMED                                                                                                                                                                                                                                                                                                        
L5580001003PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET,            Prep AK ischial thermo mold 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5580002004NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, THERMOPLASTIC OR EQUAL,                                                                                                                                                                                                                                            
L5580003004MOLDED TO MODEL                                                                                                                                                                                                                                                                                                      
L5585001003PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION, ISCHIAL LEVEL SOCKET,           Prep AK ischial open end    38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5585002004NON-ALIGNABLE SYSTEM, PYLON, NO COVER, SACH FOOT, PREFABRICATED ADJUSTABLE OPEN                                                                                                                                                                                                                                      
L5585003004END SOCKET                                                                                                                                                                                                                                                                                                           
L5590001003PREPARATORY, ABOVE KNEE - KNEE DISARTICULATION ISCHIAL LEVEL SOCKET,            Prep AK ischial laminated   38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5590002004NON-ALIGNABLE SYSTEM, PYLON NO COVER, SACH FOOT,  LAMINATED SOCKET, MOLDED TO                                                                                                                                                                                                                                        
L5590003004MODEL                                                                                                                                                                                                                                                                                                                
L5595001003PREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT,    Hip disartic sach thermopls 38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5595002004THERMOPLASTIC OR EQUAL, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                      
L5600001003PREPARATORY, HIP DISARTICULATION-HEMIPELVECTOMY, PYLON, NO COVER, SACH FOOT,    Hip disart sach laminat mold38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5600002004LAMINATED SOCKET, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                            
L5610001003ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, HYDRACADENCE      Above knee hydracadence     38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5610002004SYSTEM                                                                                                                                                                                                                                                                                                               
L5611001003ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE - KNEE             Ak 4 bar link w/fric swing  38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5611002004DISARTICULATION, 4 BAR LINKAGE, WITH FRICTION SWING PHASE CONTROL                                                                                                                                                                                                                                                    
L5613001003ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE-KNEE               Ak 4 bar ling w/hydraul swig38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5613002004DISARTICULATION, 4 BAR LINKAGE, WITH HYDRAULIC SWING PHASE CONTROL                                                                                                                                                                                                                                                   
L5614001003ADDITION TO LOWER EXTREMITY, EXOSKELETAL SYSTEM, ABOVE KNEE-KNEE                4-bar link above knee w/swng38      A                                                                                                     C                          D1F P      01994010119960101        N                           
L5614002004DISARTICULATION, 4 BAR LINKAGE, WITH PNEUMATIC SWING PHASE CONTROL                                                                                                                                                                                                                                                   
L5616001003ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, UNIVERSAL         Ak univ multiplex sys frict 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5616002004MULTIPLEX SYSTEM, FRICTION SWING PHASE CONTROL                                                                                                                                                                                                                                                                       
L5617001003ADDITION TO LOWER EXTREMITY, QUICK CHANGE SELF-ALIGNING UNIT, ABOVE KNEE OR     AK/BK self-aligning unit ea 38      A                                                                                                     C                          D1F P      01996010119960101        N                           
L5617002004BELOW KNEE, EACH                                                                                                                                                                                                                                                                                                     
L5618001003ADDITION TO LOWER EXTREMITY, TEST SOCKET, SYMES                                 Test socket symes           38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5620001003ADDITION TO LOWER EXTREMITY, TEST SOCKET, BELOW KNEE                            Test socket below knee      38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5622001003ADDITION TO LOWER EXTREMITY, TEST SOCKET, KNEE DISARTICULATION                  Test socket knee disarticula38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5624001003ADDITION TO LOWER EXTREMITY, TEST SOCKET, ABOVE KNEE                            Test socket above knee      38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5626001003ADDITION TO LOWER EXTREMITY, TEST SOCKET, HIP DISARTICULATION                   Test socket hip disarticulat38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5628001003ADDITION TO LOWER EXTREMITY, TEST SOCKET, HEMIPELVECTOMY                        Test socket hemipelvectomy  38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5629001003ADDITION TO LOWER EXTREMITY, BELOW KNEE, ACRYLIC SOCKET                         Below knee acrylic socket   38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5630001003ADDITION TO LOWER EXTREMITY, SYMES TYPE, EXPANDABLE WALL SOCKET                 Syme typ expandabl wall sckt38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5631001003ADDITION TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, ACRYLIC SOCKET Ak/knee disartic acrylic soc38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5632001003ADDITION TO LOWER EXTREMITY, SYMES TYPE,  'PTB' BRIM DESIGN SOCKET              Symes type ptb brim design s38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5634001003ADDITION TO LOWER EXTREMITY, SYMES TYPE, POSTERIOR OPENING (CANADIAN) SOCKET    Symes type poster opening so38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5636001003ADDITION  TO LOWER EXTREMITY, SYMES TYPE, MEDIAL OPENING SOCKET                 Symes type medial opening so38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5637001003ADDITION TO LOWER EXTREMITY, BELOW KNEE, TOTAL CONTACT                          Below knee total contact    38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5638001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, LEATHER SOCKET                        Below knee leather socket   38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5639001003ADDITION TO LOWER EXTREMITY, BELOW KNEE, WOOD SOCKET                            Below knee wood socket      38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5640001003ADDITION  TO LOWER EXTREMITY, KNEE DISARTICULATION, LEATHER SOCKET              Knee disarticulat leather so38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5642001003ADDITION  TO LOWER EXTREMITY, ABOVE KNEE, LEATHER SOCKET                        Above knee leather socket   38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5643001003ADDITION  TO LOWER EXTREMITY, HIP DISARTICULATION, FLEXIBLE INNER SOCKET,       Hip flex inner socket ext fr38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5643002004EXTERNAL FRAME                                                                                                                                                                                                                                                                                                       
L5644001003ADDITION  TO LOWER EXTREMITY, ABOVE KNEE, WOOD SOCKET                           Above knee wood socket      38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5645001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME Bk flex inner socket ext fra38      A                                                                                                     C                          D1F P      01988010120001213        N                           
L5646001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, AIR, FLUID, GEL OR EQUAL, CUSHION     Below knee cushion socket   38      A                                                                                                     C                          D1F P      01986010120040101        N                           
L5646002004SOCKET                                                                                                                                                                                                                                                                                                               
L5647001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE SUCTION SOCKET                         Below knee suction socket   38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5648001003ADDITION  TO LOWER EXTREMITY, ABOVE KNEE, AIR, FLUID, GEL OR EQUAL,  CUSHION    Above knee cushion socket   38      A                                                                                                     C                          D1F P      01986010120040101        N                           
L5648002004SOCKET                                                                                                                                                                                                                                                                                                               
L5649001003ADDITION  TO LOWER EXTREMITY, ISCHIAL CONTAINMENT/NARROW M-L SOCKET             Isch containmt/narrow m-l so38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5650001003ADDITIONS TO LOWER EXTREMITY, TOTAL CONTACT, ABOVE KNEE OR KNEE DISARTICULATION Tot contact ak/knee disart s38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5650002004SOCKET                                                                                                                                                                                                                                                                                                               
L5651001003ADDITION  TO LOWER EXTREMITY, ABOVE KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME Ak flex inner socket ext fra38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5652001003ADDITION  TO LOWER EXTREMITY, SUCTION SUSPENSION, ABOVE KNEE OR KNEE            Suction susp ak/knee disart 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5652002004DISARTICULATION SOCKET                                                                                                                                                                                                                                                                                               
L5653001003ADDITION  TO LOWER EXTREMITY, KNEE DISARTICULATION, EXPANDABLE WALL SOCKET      Knee disart expand wall sock38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5654001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, SYMES, (KEMBLO, PELITE, ALIPLAST,  Socket insert symes         38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5654002004PLASTAZOTE OR EQUAL)                                                                                                                                                                                                                                                                                                 
L5655001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, BELOW KNEE (KEMBLO, PELITE,        Socket insert below knee    38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5655002004ALIPLAST, PLASTAZOTE OR EQUAL)                                                                                                                                                                                                                                                                                       
L5656001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, KNEE DISARTICULATION (KEMBLO,      Socket insert knee articulat38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5656002004PELITE, ALIPLAST, PLASTAZOTE OR EQUAL)                                                                                                                                                                                                                                                                               
L5658001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, ABOVE KNEE (KEMBLO, PELITE,        Socket insert above knee    38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5658002004ALIPLAST, PLASTAZOTE OR EQUAL)                                                                                                                                                                                                                                                                                       
L5660001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, SYMES, SILICONE GEL OR EQUAL       Sock insrt syme silicone gel00      9                                                                                                     G                          D1F P      0198601012003010120021231N                           
L5661001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER SYMES              Multi-durometer symes       38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5662001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, BELOW KNEE, SILICONE GEL OR EQUAL  Socket insert bk silicone ge00      9                                                                                                     G                          D1F P      0198601012003010120021231N                           
L5663001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, KNEE DISARTICULATION, SILICONE GEL Sock knee disartic silicone 00      9                                                                                                     G                          D1F P      0198601012003010120021231N                           
L5663002004OR EQUAL                                                                                                                                                                                                                                                                                                             
L5664001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, ABOVE KNEE, SILICONE GEL OR EQUAL  Socket insert ak silicone ge00      9                                                                                                     G                          D1F P      0198601012003010120021231N                           
L5665001003ADDITION  TO LOWER EXTREMITY, SOCKET INSERT, MULTI-DUROMETER, BELOW KNEE        Multi-durometer below knee  38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5666001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, CUFF SUSPENSION                       Below knee cuff suspension  38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5668001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, MOLDED DISTAL CUSHION                 Socket insert w/o lock lower38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5670001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, MOLDED SUPRACONDYLAR SUSPENSION       Bk molded supracondylar susp38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5670002004('PTS' OR SIMILAR)                                                                                                                                                                                                                                                                                                   
L5671001003ADDITION TO LOWER EXTREMITY, BELOW KNEE / ABOVE KNEE SUSPENSION LOCKING         BK/AK locking mechanism     38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L5671002004MECHANISM (SHUTTLE, LANYARD OR EQUAL), EXCLUDES SOCKET INSERT                                                                                                                                                                                                                                                        
L5672001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, REMOVABLE MEDIAL BRIM SUSPENSION      Bk removable medial brim sus38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5673001003ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM      Socket insert w lock mech   38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L5673002004EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR                                                                                                                                                                                                                                          
L5673003004EQUAL, FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                                
L5674001003ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, ANY MATERIAL,  EACH Bk suspension sleeve        38      A                                                                            L5685                    C                          D1F P      0198601012005010120041231N                           
L5675001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, HEAVY DUTY, ANY    Bk heavy duty susp sleeve   38      A                                                                            L5685                    C                          D1F P      0198801012005010120041231N                           
L5675002004MATERIAL, EACH                                                                                                                                                                                                                                                                                                       
L5676001003ADDITIONS TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, SINGLE AXIS, PAIR        Bk knee joints single axis p38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5677001003ADDITIONS TO LOWER EXTREMITY, BELOW KNEE, KNEE JOINTS, POLYCENTRIC, PAIR        Bk knee joints polycentric p38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5678001003ADDITIONS TO LOWER EXTREMITY, BELOW KNEE, JOINT COVERS, PAIR                    Bk joint covers pair        38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L5679001003ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED FROM      Socket insert w/o lock mech 38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L5679002004EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL, ELASTOMERIC OR                                                                                                                                                                                                                                          
L5679003004EQUAL, NOT FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                            
L5680001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, NONMOLDED                Bk thigh lacer non-molded   38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5681001003ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET    Intl custm cong/latyp insert38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L5681002004INSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC                                                                                                                                                                                                                                       
L5681003004OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER                                                                                                                                                                                                                                         
L5681004004THAN INITIAL, USE CODE L5673 OR L5679)                                                                                                                                                                                                                                                                               
L5682001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, THIGH LACER, GLUTEAL/ISCHIAL, MOLDED  Bk thigh lacer glut/ischia m38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5683001003ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET    Initial custom socket insert38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L5683002004INSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL,                                                                                                                                                                                                                                        
L5683003004ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY                                                                                                                                                                                                                                        
L5683004004(FOR OTHER THAN INITIAL, USE CODE L5673 OR L5679)                                                                                                                                                                                                                                                                    
L5684001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, FORK STRAP                            Bk fork strap               38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5685001003ADDITION TO LOWER EXTREMITY PROSTHESIS, BELOW KNEE, SUSPENSION/SEALING SLEEVE,  Below knee sus/seal sleeve  38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L5685002004WITH OR WITHOUT VALVE, ANY MATERIAL, EACH                                                                                                                                                                                                                                                                            
L5686001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, BACK CHECK (EXTENSION CONTROL)        Bk back check               38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5688001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, WAIST BELT, WEBBING                   Bk waist belt webbing       38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5690001003ADDITION  TO LOWER EXTREMITY, BELOW KNEE, WAIST BELT, PADDED AND LINED          Bk waist belt padded and lin38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5692001003ADDITION  TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, LIGHT            Ak pelvic control belt light38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5694001003ADDITION  TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL BELT, PADDED AND LINED Ak pelvic control belt pad/l38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5695001003ADDITION TO LOWER EXTREMITY, ABOVE KNEE, PELVIC CONTROL, SLEEVE SUSPENSION,     Ak sleeve susp neoprene/equa38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5695002004NEOPRENE OR EQUAL, EACH                                                                                                                                                                                                                                                                                              
L5696001003ADDITION  TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC JOINT  Ak/knee disartic pelvic join38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5697001003ADDITION  TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, PELVIC BAND   Ak/knee disartic pelvic band38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5698001003ADDITION  TO LOWER EXTREMITY, ABOVE KNEE OR KNEE DISARTICULATION, SILESIAN      Ak/knee disartic silesian ba38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5698002004BANDAGE                                                                                                                                                                                                                                                                                                              
L5699001003ALL LOWER EXTREMITY PROSTHESES, SHOULDER HARNESS                                Shoulder harness            38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5700001003REPLACEMENT, SOCKET, BELOW KNEE, MOLDED TO PATIENT MODEL                        Replace socket below knee   38      A                                                                                                     C                          D1F P      01994010119940101        N                           
L5701001003REPLACEMENT, SOCKET, ABOVE KNEE/KNEE DISARTICULATION, INCLUDING ATTACHMENT      Replace socket above knee   38      A                                                                                                     C                          D1F P      01994010119940101        N                           
L5701002004PLATE, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                                                       
L5702001003REPLACEMENT, SOCKET, HIP DISARTICULATION, INCLUDING HIP JOINT, MOLDED TO        Replace socket hip          38      A                                                                                                     C                          D1F P      01994010119940101        N                           
L5702002004PATIENT MODEL                                                                                                                                                                                                                                                                                                        
L5703001003ANKLE, SYMES, MOLDED TO PATIENT MODEL, SOCKET WITHOUT SOLID ANKLE CUSHION HEEL  Symes ankle w/o (SACH) foot 38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L5703002004(SACH) FOOT, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                        
L5704001003CUSTOM SHAPED PROTECTIVE COVER, BELOW KNEE                                      Custom shape cover BK       38      A                                                                                                     C                          D1F P      01994010120020101        N                           
L5705001003CUSTOM SHAPED PROTECTIVE COVER, ABOVE KNEE                                      Custom shape cover AK       38      A                                                                                                     C                          D1F P      01994010120020101        N                           
L5706001003CUSTOM SHAPED PROTECTIVE COVER, KNEE DISARTICULATION                            Custom shape cvr knee disart38      A                                                                                                     C                          D1F P      01994010120020101        N                           
L5707001003CUSTOM SHAPED PROTECTIVE COVER, HIP DISARTICULATION                             Custom shape cvr hip disart 38      A                                                                                                     C                          D1F P      01994010120020101        N                           
L5710001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK               Kne-shin exo sng axi mnl loc38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5711001003ADDITIONS EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT   Knee-shin exo mnl lock ultra38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5711002004MATERIAL                                                                                                                                                                                                                                                                                                             
L5712001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE Knee-shin exo frict swg & st38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5712002004PHASE CONTROL (SAFETY KNEE)                                                                                                                                                                                                                                                                                          
L5714001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, VARIABLE FRICTION SWING   Knee-shin exo variable frict38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5714002004PHASE CONTROL                                                                                                                                                                                                                                                                                                        
L5716001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE   Knee-shin exo mech stance ph38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5716002004LOCK                                                                                                                                                                                                                                                                                                                 
L5718001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC,  FRICTION SWING AND       Knee-shin exo frct swg & sta38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5718002004STANCE PHASE CONTROL                                                                                                                                                                                                                                                                                                 
L5722001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION Knee-shin pneum swg frct exo38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5722002004STANCE PHASE CONTROL                                                                                                                                                                                                                                                                                                 
L5724001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL Knee-shin exo fluid swing ph38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5726001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, EXTERNAL JOINTS FLUID     Knee-shin ext jnts fld swg e38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5726002004SWING PHASE CONTROL                                                                                                                                                                                                                                                                                                  
L5728001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE    Knee-shin fluid swg & stance38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5728002004PHASE CONTROL                                                                                                                                                                                                                                                                                                        
L5780001003ADDITION,  EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/HYDRA PNEUMATIC Knee-shin pneum/hydra pneum 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L5780002004SWING PHASE CONTROL                                                                                                                                                                                                                                                                                                  
L5781001003ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT Lower limb pros vacuum pump 38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L5781002004AND MOISTURE EVACUATION SYSTEM                                                                                                                                                                                                                                                                                       
L5782001003ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT HD low limb pros vacuum pump38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L5782002004AND MOISTURE EVACUATION SYSTEM, HEAVY DUTY                                                                                                                                                                                                                                                                           
L5785001003ADDITION, EXOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,       Exoskeletal bk ultralt mater38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5785002004CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                               
L5790001003ADDITION, EXOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,       Exoskeletal ak ultra-light m38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5790002004CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                               
L5795001003ADDITION, EXOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL         Exoskel hip ultra-light mate38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5795002004(TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                    
L5810001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK               Endoskel knee-shin mnl lock 38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5811001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, MANUAL LOCK, ULTRA-LIGHT  Endo knee-shin mnl lck ultra38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5811002004MATERIAL                                                                                                                                                                                                                                                                                                             
L5812001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE Endo knee-shin frct swg & st38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5812002004PHASE CONTROL (SAFETY KNEE)                                                                                                                                                                                                                                                                                          
L5814001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, HYDRAULIC SWING PHASE     Endo knee-shin hydral swg ph38      A                                                                                                     C                          D1F P      01997010119970101        N                           
L5814002004CONTROL, MECHANICAL STANCE PHASE LOCK                                                                                                                                                                                                                                                                                
L5816001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE   Endo knee-shin polyc mch sta38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5816002004LOCK                                                                                                                                                                                                                                                                                                                 
L5818001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING, AND       Endo knee-shin frct swg & st38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5818002004STANCE PHASE CONTROL                                                                                                                                                                                                                                                                                                 
L5822001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION Endo knee-shin pneum swg frc38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5822002004STANCE PHASE CONTROL                                                                                                                                                                                                                                                                                                 
L5824001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL Endo knee-shin fluid swing p38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5826001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, HYDRAULIC SWING PHASE     Miniature knee joint        38      A                                                                                                     C                          D1F P      01998010119990101        N                           
L5826002004CONTROL, WITH MINIATURE HIGH ACTIVITY FRAME                                                                                                                                                                                                                                                                          
L5828001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE    Endo knee-shin fluid swg/sta38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5828002004PHASE CONTROL                                                                                                                                                                                                                                                                                                        
L5830001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/ SWING PHASE    Endo knee-shin pneum/swg pha38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5830002004CONTROL                                                                                                                                                                                                                                                                                                              
L5840001003ADDITION, ENDOSKELETAL KNEE/SHIN SYSTEM, 4-BAR LINKAGE OR MULTIAXIAL, PNEUMATIC Multi-axial knee/shin system38      A                                                                                                     C                          D1F P      01994010119990101        N                           
L5840002004SWING PHASE CONTROL                                                                                                                                                                                                                                                                                                  
L5845001003ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, STANCE FLEXION FEATURE, ADJUSTABLE    Knee-shin sys stance flexion38      A                                                                                                     C                          D1F P      01996010119960101        N                           
L5846001003ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING Knee-shin sys microprocessor38      A                                                                                                     C                          D1F P      0199601012005010120041231N                           
L5846002004PHASE ONLY                                                                                                                                                                                                                                                                                                           
L5847001003ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE Microprocessor cntrl feature38      A                                                                                                     C                          D1F P      0200201012005010120041231N                           
L5847002004PHASE                                                                                                                                                                                                                                                                                                                
L5848001003ADDITION TO ENDOSKELETAL, KNEE-SHIN SYSTEM, HYDRAULIC STANCE EXTENSION,         Knee-shin sys hydraul stance38      A                                                                                                     C                          D1F P      02003010120040101        N                           
L5848002004DAMPENING FEATURE, WITH OR WITHOUT ADJUSTABILITY                                                                                                                                                                                                                                                                     
L5850001003ADDITION,  ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, KNEE         Endo ak/hip knee extens assi38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5850002004EXTENSION ASSIST                                                                                                                                                                                                                                                                                                     
L5855001003ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, MECHANICAL HIP EXTENSION    Mech hip extension assist   38      A                                                                                                     C                          D1F P      01994010119950101        N                           
L5855002004ASSIST                                                                                                                                                                                                                                                                                                               
L5856001003ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM,          Elec knee-shin swing/stance 38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L5856002004MICROPROCESSOR CONTROL FEATURE, SWING AND STANCE PHASE, INCLUDES ELECTRONIC                                                                                                                                                                                                                                          
L5856003004SENSOR(S), ANY TYPE                                                                                                                                                                                                                                                                                                  
L5857001003ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM,          Elec knee-shin swing only   38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L5857002004MICROPROCESSOR CONTROL FEATURE, SWING PHASE ONLY, INCLUDES ELECTRONIC                                                                                                                                                                                                                                                
L5857003004SENSOR(S), ANY TYPE                                                                                                                                                                                                                                                                                                  
L5858001003ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM,          Stance phase only           38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L5858002004MICROPROCESSOR CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC                                                                                                                                                                                                                                               
L5858003004SENSOR(S), ANY TYPE                                                                                                                                                                                                                                                                                                  
L5910001003ADDITION,  ENDOSKELETAL SYSTEM, BELOW KNEE, ALIGNABLE SYSTEM                    Endo below knee alignable sy38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5920001003ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE OR HIP DISARTICULATION, ALIGNABLE     Endo ak/hip alignable system38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5920002004SYSTEM                                                                                                                                                                                                                                                                                                               
L5925001003ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, KNEE DISARTICULATION OR HIP          Above knee manual lock      38      A                                                                                                     C                          D1F P      01994010120000101        N                           
L5925002004DISARTICULATION, MANUAL LOCK                                                                                                                                                                                                                                                                                         
L5930001003ADDITION, ENDOSKELETAL SYSTEM, HIGH ACTIVITY KNEE CONTROL FRAME                 High activity knee frame    38      A                                                                                                     C                          D1F P      01996010119960101        N                           
L5940001003ADDITION,  ENDOSKELETAL SYSTEM, BELOW KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,     Endo bk ultra-light material38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5940002004CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                               
L5950001003ADDITION,  ENDOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM,     Endo ak ultra-light material38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5950002004CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                               
L5960001003ADDITION,  ENDOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL       Endo hip ultra-light materia38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L5960002004(TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                                    
L5962001003ADDITION, ENDOSKELETAL SYSTEM, BELOW KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE    Below knee flex cover system38      A                                                                                                     C                          D1F P      01994010119940101        N                           
L5962002004COVERING SYSTEM                                                                                                                                                                                                                                                                                                      
L5964001003ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE    Above knee flex cover system38      A                                                                                                     C                          D1F P      01994010119940101        N                           
L5964002004COVERING SYSTEM                                                                                                                                                                                                                                                                                                      
L5966001003ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, FLEXIBLE PROTECTIVE OUTER   Hip flexible cover system   38      A                                                                                                     C                          D1F P      01994010119940101        N                           
L5966002004SURFACE COVERING SYSTEM                                                                                                                                                                                                                                                                                              
L5968001003ADDITION TO LOWER LIMB PROSTHESIS, MULTIAXIAL ANKLE WITH SWING PHASE ACTIVE     Multiaxial ankle w dorsiflex38      A                                                                                                     C                          D1F P      01999010120000101        N                           
L5968002004DORSIFLEXION FEATURE                                                                                                                                                                                                                                                                                                 
L5970001003ALL LOWER EXTREMITY PROSTHESES, FOOT, EXTERNAL KEEL, SACH FOOT                  Foot external keel sach foot38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5971001003ALL LOWER EXTREMITY PROSTHESIS, SOLID ANKLE CUSHION HEEL (SACH) FOOT,           SACH foot, replacement      38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L5971002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
L5972001003ALL LOWER EXTREMITY PROSTHESES, FLEXIBLE KEEL FOOT (SAFE, STEN, BOCK DYNAMIC OR Flexible keel foot          38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5972002004EQUAL)                                                                                                                                                                                                                                                                                                               
L5974001003ALL LOWER EXTREMITY PROSTHESES, FOOT, SINGLE AXIS ANKLE/FOOT                    Foot single axis ankle/foot 38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5975001003ALL LOWER EXTREMITY PROSTHESIS, COMBINATION SINGLE AXIS ANKLE AND FLEXIBLE KEEL Combo ankle/foot prosthesis 38      A                                                                                                     C                          D1F P      01999010119990101        N                           
L5975002004FOOT                                                                                                                                                                                                                                                                                                                 
L5976001003ALL LOWER EXTREMITY PROSTHESES, ENERGY STORING FOOT (SEATTLE CARBON COPY II OR  Energy storing foot         38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5976002004EQUAL)                                                                                                                                                                                                                                                                                                               
L5978001003ALL LOWER EXTREMITY PROSTHESES, FOOT, MULTIAXIAL ANKLE/FOOT                     Ft prosth multiaxial ankl/ft38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5979001003ALL LOWER EXTREMITY PROSTHESIS, MULTI-AXIAL ANKLE, DYNAMIC RESPONSE FOOT, ONE   Multi-axial ankle/ft prosth 38      A                                                                                                     C                          D1F P      01994010120010101        N                           
L5979002004PIECE SYSTEM                                                                                                                                                                                                                                                                                                         
L5980001003ALL LOWER EXTREMITY PROSTHESES, FLEX FOOT SYSTEM                                Flex foot system            38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5981001003ALL LOWER EXTREMITY PROSTHESES, FLEX-WALK SYSTEM OR EQUAL                       Flex-walk sys low ext prosth38      A                                                                                                     C                          D1F P      01994010119940101        N                           
L5982001003ALL EXOSKELETAL LOWER EXTREMITY PROSTHESES, AXIAL ROTATION UNIT                 Exoskeletal axial rotation u38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5984001003ALL ENDOSKELETAL LOWER EXTREMITY PROSTHESIS, AXIAL ROTATION UNIT, WITH OR       Endoskeletal axial rotation 38      A                                                                                                     C                          D1F P      01989010120040101        N                           
L5984002004WITHOUT ADJUSTABILITY                                                                                                                                                                                                                                                                                                
L5985001003ALL ENDOSKELETAL LOWER EXTREMITY PROSTHESES, DYNAMIC PROSTHETIC PYLON           Lwr ext dynamic prosth pylon38      A                                                                                                     C                          D1F P      01996010119960101        N                           
L5986001003ALL LOWER EXTREMITY PROSTHESES, MULTI-AXIAL ROTATION UNIT ('MCP' OR EQUAL)      Multi-axial rotation unit   38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L5987001003ALL LOWER EXTREMITY PROSTHESIS, SHANK FOOT SYSTEM WITH VERTICAL LOADING PYLON   Shank ft w vert load pylon  38      A                                                                                                     C                          D1F P      01997010119970101        N                           
L5988001003ADDITION TO LOWER LIMB PROSTHESIS, VERTICAL SHOCK REDUCING PYLON FEATURE        Vertical shock reducing pylo38      A                                                                                                     C                          D1F P      01999010120000101        N                           
L5989001003ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL SYSTEM, PYLON WITH         Pylon w elctrnc force sensor38      A                                                                                                     C                          D1F P      0200201012005010120041231N                           
L5989002004INTEGRATED ELECTRONIC FORCE SENSORS                                                                                                                                                                                                                                                                                  
L5990001003ADDITION TO LOWER EXTREMITY PROSTHESIS, USER ADJUSTABLE HEEL HEIGHT             User adjustable heel height 38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L5995001003ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE (FOR PATIENT WEIGHT  Lower ext pros heavyduty fea38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L5995002004> 300 LBS)                                                                                                                                                                                                                                                                                                           
L5999001003LOWER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED                             Lowr extremity prosthes NOS 46      A                                                                                                     C                          D1F P      01982010119980101        N                           
L6000001003PARTIAL HAND, ROBIN-AIDS, THUMB REMAINING (OR EQUAL)                            Par hand robin-aids thum rem38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6010001003PARTIAL HAND, ROBIN-AIDS, LITTLE AND/OR RING FINGER REMAINING (OR EQUAL)        Hand robin-aids little/ring 38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6020001003PARTIAL HAND, ROBIN-AIDS, NO FINGER REMAINING (OR EQUAL)                        Part hand robin-aids no fing38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6025001003TRANSCARPAL/METACARPAL OR PARTIAL HAND DISARTICULATION PROSTHESIS, EXTERNAL     Part hand disart myoelectric38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L6025002004POWER, SELF-SUSPENDED, INNER SOCKET WITH REMOVABLE FOREARM SECTION, ELECTRODES                                                                                                                                                                                                                                       
L6025003004AND CABLES, TWO BATTERIES, CHARGER, MYOELECTRIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                           
L6050001003WRIST DISARTICULATION, MOLDED SOCKET, FLEXIBLE ELBOW HINGES, TRICEPS PAD        Wrst MLd sck flx hng tri pad38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6055001003WRIST DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, FLEXIBLE ELBOW  Wrst mold sock w/exp interfa38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6055002004HINGES, TRICEPS PAD                                                                                                                                                                                                                                                                                                  
L6100001003BELOW ELBOW, MOLDED SOCKET, FLEXIBLE ELBOW HINGE, TRICEPS PAD                   Elb mold sock flex hinge pad38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6110001003BELOW ELBOW, MOLDED SOCKET, (MUENSTER OR NORTHWESTERN SUSPENSION TYPES)         Elbow mold sock suspension t38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6120001003BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STEP-UP HINGES, HALF CUFF         Elbow mold doub splt soc ste38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6130001003BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STUMP ACTIVATED LOCKING HINGE,    Elbow stump activated lock h38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6130002004HALF CUFF                                                                                                                                                                                                                                                                                                            
L6200001003ELBOW DISARTICULATION, MOLDED SOCKET, OUTSIDE LOCKING HINGE, FOREARM            Elbow mold outsid lock hinge38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6205001003ELBOW DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, OUTSIDE LOCKING Elbow molded w/ expand inter38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6205002004HINGES, FOREARM                                                                                                                                                                                                                                                                                                      
L6250001003ABOVE ELBOW, MOLDED DOUBLE WALL SOCKET, INTERNAL LOCKING ELBOW, FOREARM         Elbow inter loc elbow forarm38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6300001003SHOULDER DISARTICULATION, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION,    Shlder disart int lock elbow38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6300002004INTERNAL LOCKING ELBOW, FOREARM                                                                                                                                                                                                                                                                                      
L6310001003SHOULDER DISARTICULATION, PASSIVE RESTORATION (COMPLETE PROSTHESIS)             Shoulder passive restor comp38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6320001003SHOULDER DISARTICULATION, PASSIVE RESTORATION (SHOULDER CAP ONLY)               Shoulder passive restor cap 38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6350001003INTERSCAPULAR THORACIC, MOLDED SOCKET, SHOULDER BULKHEAD, HUMERAL SECTION,      Thoracic intern lock elbow  38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L6350002004INTERNAL LOCKING ELBOW, FOREARM                                                                                                                                                                                                                                                                                      
L6360001003INTERSCAPULAR THORACIC, PASSIVE RESTORATION (COMPLETE PROSTHESIS)               Thoracic passive restor comp38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6370001003INTERSCAPULAR THORACIC, PASSIVE RESTORATION (SHOULDER CAP ONLY)                 Thoracic passive restor cap 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6380001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID          Postop dsg cast chg wrst/elb38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6380002004DRESSING, INCLUDING FITTING ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE                                                                                                                                                                                                                                          
L6380003004CAST CHANGE, WRIST DISARTICULATION OR BELOW ELBOW                                                                                                                                                                                                                                                                    
L6382001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING Postop dsg cast chg elb dis/38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6382002004INCLUDING FITTING ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE CAST CHANGE,                                                                                                                                                                                                                                       
L6382003004ELBOW DISARTICULATION OR ABOVE ELBOW                                                                                                                                                                                                                                                                                 
L6384001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF INITIAL RIGID DRESSING Postop dsg cast chg shlder/t38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6384002004INCLUDING FITTING ALIGNMENT AND SUSPENSION OF COMPONENTS, AND ONE CAST CHANGE,                                                                                                                                                                                                                                       
L6384003004SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC                                                                                                                                                                                                                                                                   
L6386001003IMMEDIATE POST SURGICAL OR EARLY FITTING, EACH ADDITIONAL CAST CHANGE AND       Postop ea cast chg & realign38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6386002004REALIGNMENT                                                                                                                                                                                                                                                                                                          
L6388001003IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF RIGID DRESSING ONLY    Postop applicat rigid dsg on38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6400001003BELOW ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC      Below elbow prosth tiss shap38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6400002004TISSUE SHAPING                                                                                                                                                                                                                                                                                                       
L6450001003ELBOW DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT       Elb disart prosth tiss shap 38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6450002004PROSTHETIC TISSUE SHAPING                                                                                                                                                                                                                                                                                            
L6500001003ABOVE ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC      Above elbow prosth tiss shap38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6500002004TISSUE SHAPING                                                                                                                                                                                                                                                                                                       
L6550001003SHOULDER DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT    Shldr disar prosth tiss shap38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L6550002004PROSTHETIC TISSUE SHAPING                                                                                                                                                                                                                                                                                            
L6570001003INTERSCAPULAR THORACIC, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT      Scap thorac prosth tiss shap38      A                                                                                                     C                          D1F P      01984010119960101        N                           
L6570002004PROSTHETIC TISSUE SHAPING                                                                                                                                                                                                                                                                                            
L6580001003PREPARATORY, WRIST DISARTICULATION OR BELOW ELBOW, SINGLE WALL PLASTIC SOCKET,  Wrist/elbow bowden cable mol38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6580002004FRICTION WRIST, FLEXIBLE ELBOW HINGES, FIGURE OF EIGHT HARNESS, HUMERAL CUFF,                                                                                                                                                                                                                                        
L6580003004BOWDEN CABLE CONTROL, USMC OR EQUAL PYLON, NO COVER, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                         
L6582001003PREPARATORY, WRIST DISARTICULATION OR BELOW ELBOW, SINGLE WALL SOCKET, FRICTION Wrist/elbow bowden cbl dir f38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6582002004WRIST, FLEXIBLE ELBOW HINGES, FIGURE OF EIGHT HARNESS, HUMERAL CUFF, BOWDEN                                                                                                                                                                                                                                          
L6582003004CABLE CONTROL, USMC OR EQUAL PYLON, NO COVER, DIRECT FORMED                                                                                                                                                                                                                                                          
L6584001003PREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL PLASTIC SOCKET,  Elbow fair lead cable molded38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6584002004FRICTION WRIST, LOCKING ELBOW, FIGURE OF EIGHT HARNESS, FAIR LEAD CABLE                                                                                                                                                                                                                                              
L6584003004CONTROL, USMC OR EQUAL PYLON, NO COVER, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                                      
L6586001003PREPARATORY, ELBOW DISARTICULATION OR ABOVE ELBOW, SINGLE WALL SOCKET, FRICTION Elbow fair lead cable dir fo38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6586002004WRIST, LOCKING ELBOW, FIGURE OF EIGHT HARNESS, FAIR LEAD CABLE CONTROL, USMC OR                                                                                                                                                                                                                                      
L6586003004EQUAL PYLON, NO COVER, DIRECT FORMED                                                                                                                                                                                                                                                                                 
L6588001003PREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL    Shdr fair lead cable molded 38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6588002004PLASTIC SOCKET, SHOULDER JOINT, LOCKING ELBOW, FRICTION WRIST, CHEST STRAP,                                                                                                                                                                                                                                          
L6588003004FAIR LEAD CABLE CONTROL, USMC OR EQUAL PYLON, NO COVER, MOLDED TO PATIENT MODEL                                                                                                                                                                                                                                      
L6590001003PREPARATORY, SHOULDER DISARTICULATION OR INTERSCAPULAR THORACIC, SINGLE WALL    Shdr fair lead cable direct 38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6590002004SOCKET, SHOULDER JOINT, LOCKING ELBOW, FRICTION WRIST, CHEST STRAP, FAIR LEAD                                                                                                                                                                                                                                        
L6590003004CABLE CONTROL, USMC OR EQUAL PYLON, NO COVER, DIRECT FORMED                                                                                                                                                                                                                                                          
L6600001003UPPER EXTREMITY ADDITIONS, POLYCENTRIC HINGE, PAIR                              Polycentric hinge pair      38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6605001003UPPER EXTREMITY ADDITIONS, SINGLE PIVOT HINGE, PAIR                             Single pivot hinge pair     38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6610001003UPPER EXTREMITY ADDITIONS, FLEXIBLE METAL HINGE, PAIR                           Flexible metal hinge pair   38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6615001003UPPER EXTREMITY ADDITION,  DISCONNECT LOCKING WRIST UNIT                        Disconnect locking wrist uni38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6616001003UPPER EXTREMITY ADDITION, ADDITIONAL DISCONNECT INSERT FOR LOCKING WRIST UNIT,  Disconnect insert locking wr38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L6616002004EACH                                                                                                                                                                                                                                                                                                                 
L6620001003UPPER EXTREMITY ADDITION,  FLEXION/EXTENSION WRIST UNIT, WITH OR WITHOUT        Flexion/extension wrist unit38      A                                                                                                     C                          D1F P      01986010120040101        N                           
L6620002004FRICTION                                                                                                                                                                                                                                                                                                             
L6621001003UPPER EXTREMITY PROSTHESIS ADDITION, FLEXION/EXTENSION WRIST WITH OR WITHOUT    Flex/ext wrist w/wo friction38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L6621002004FRICTION, FOR USE WITH EXTERNAL POWERED TERMINAL DEVICE                                                                                                                                                                                                                                                              
L6623001003UPPER EXTREMITY ADDITION,  SPRING ASSISTED ROTATIONAL WRIST UNIT WITH LATCH     Spring-ass rot wrst w/ latch38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6623002004RELEASE                                                                                                                                                                                                                                                                                                              
L6625001003UPPER EXTREMITY ADDITION,  ROTATION WRIST UNIT WITH CABLE LOCK                  Rotation wrst w/ cable lock 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6628001003UPPER EXTREMITY ADDITION,  QUICK DISCONNECT HOOK ADAPTER, OTTO BOCK OR EQUAL    Quick disconn hook adapter o38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6629001003UPPER EXTREMITY ADDITION,  QUICK DISCONNECT LAMINATION COLLAR WITH COUPLING     Lamination collar w/ couplin38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6629002004PIECE, OTTO BOCK OR EQUAL                                                                                                                                                                                                                                                                                            
L6630001003UPPER EXTREMITY ADDITION,  STAINLESS STEEL, ANY WRIST                           Stainless steel any wrist   38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6632001003UPPER EXTREMITY ADDITION,  LATEX SUSPENSION SLEEVE, EACH                        Latex suspension sleeve each38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6635001003UPPER EXTREMITY ADDITION,  LIFT ASSIST FOR ELBOW                                Lift assist for elbow       38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6637001003UPPER EXTREMITY ADDITION,  NUDGE CONTROL ELBOW LOCK                             Nudge control elbow lock    38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6638001003UPPER EXTREMITY ADDITION TO PROSTHESIS, ELECTRIC LOCKING FEATURE, ONLY FOR USE  Elec lock on manual pw elbow38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L6638002004WITH MANUALLY POWERED ELBOW                                                                                                                                                                                                                                                                                          
L6640001003UPPER EXTREMITY ADDITIONS, SHOULDER ABDUCTION JOINT, PAIR                       Shoulder abduction joint pai38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6641001003UPPER EXTREMITY ADDITION,  EXCURSION AMPLIFIER, PULLEY TYPE                     Excursion amplifier pulley t38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6642001003UPPER EXTREMITY ADDITION,  EXCURSION AMPLIFIER, LEVER TYPE                      Excursion amplifier lever ty38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6645001003UPPER EXTREMITY ADDITION,  SHOULDER FLEXION-ABDUCTION JOINT, EACH               Shoulder flexion-abduction j38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6646001003UPPER EXTREMITY ADDITION, SHOULDER JOINT, MULTIPOSITIONAL LOCKING, FLEXION,     Multipo locking shoulder jnt38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L6646002004ADJUSTABLE ABDUCTION FRICTION CONTROL, FOR USE WITH BODY POWERED OR EXTERNAL                                                                                                                                                                                                                                         
L6646003004POWERED SYSTEM                                                                                                                                                                                                                                                                                                       
L6647001003UPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, BODY POWERED ACTUATOR        Shoulder lock actuator      38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L6648001003UPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, EXTERNAL POWERED ACTUATOR    Ext pwrd shlder lock/unlock 38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L6650001003UPPER EXTREMITY ADDITION,  SHOULDER UNIVERSAL JOINT, EACH                       Shoulder universal joint    38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6655001003UPPER EXTREMITY ADDITION,  STANDARD CONTROL CABLE, EXTRA                        Standard control cable extra38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6660001003UPPER EXTREMITY ADDITION,  HEAVY DUTY CONTROL CABLE                             Heavy duty control cable    38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6665001003UPPER EXTREMITY ADDITION,  TEFLON, OR EQUAL, CABLE LINING                       Teflon or equal cable lining38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6670001003UPPER EXTREMITY ADDITION,  HOOK TO HAND, CABLE ADAPTER                          Hook to hand cable adapter  38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6672001003UPPER EXTREMITY ADDITION,  HARNESS, CHEST OR SHOULDER, SADDLE TYPE              Harness chest/shlder saddle 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6675001003UPPER EXTREMITY ADDITION, HARNESS, (E.G. FIGURE OF EIGHT TYPE), SINGLE CABLE    Harness figure of 8 sing con38      A                                                                                                     C                          D1F P      01986010120040101        N                           
L6675002004DESIGN                                                                                                                                                                                                                                                                                                               
L6676001003UPPER EXTREMITY ADDITION, HARNESS, (E.G. FIGURE OF EIGHT TYPE), DUAL CABLE      Harness figure of 8 dual con38      A                                                                                                     C                          D1F P      01986010120040101        N                           
L6676002004DESIGN                                                                                                                                                                                                                                                                                                               
L6677001003UPPER EXTREMITY ADDITION, HARNESS, TRIPLE CONTROL, SIMULTANEOUS OPERATION OF    UE triple control harness   38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L6677002004TERMINAL DEVICE AND ELBOW                                                                                                                                                                                                                                                                                            
L6680001003UPPER EXTREMITY ADDITION,  TEST SOCKET, WRIST DISARTICULATION OR BELOW ELBOW    Test sock wrist disart/bel e38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6682001003UPPER EXTREMITY ADDITION,  TEST SOCKET, ELBOW DISARTICULATION OR ABOVE ELBOW    Test sock elbw disart/above 38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6684001003UPPER EXTREMITY ADDITION,  TEST SOCKET, SHOULDER DISARTICULATION OR             Test socket shldr disart/tho38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6684002004INTERSCAPULAR THORACIC                                                                                                                                                                                                                                                                                               
L6686001003UPPER EXTREMITY ADDITION,  SUCTION SOCKET                                       Suction socket              38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6687001003UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, BELOW ELBOW OR WRIST               Frame typ socket bel elbow/w38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6687002004DISARTICULATION                                                                                                                                                                                                                                                                                                      
L6688001003UPPER EXTREMITY ADDITION, FRAME TYPE SOCKET, ABOVE ELBOW OR ELBOW               Frame typ sock above elb/dis38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6688002004DISARTICULATION                                                                                                                                                                                                                                                                                                      
L6689001003UPPER EXTREMITY ADDITION,  FRAME TYPE SOCKET, SHOULDER DISARTICULATION          Frame typ socket shoulder di38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6690001003UPPER EXTREMITY ADDITION,  FRAME TYPE SOCKET, INTERSCAPULAR-THORACIC            Frame typ sock interscap-tho38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6691001003UPPER EXTREMITY ADDITION,  REMOVABLE INSERT, EACH                               Removable insert each       38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6692001003UPPER EXTREMITY ADDITION, SILICONE GEL INSERT OR EQUAL, EACH                    Silicone gel insert or equal38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L6693001003UPPER EXTREMITY ADDITION, LOCKING ELBOW, FOREARM COUNTERBALANCE                 Lockingelbow forearm cntrbal38      A                                                                                                     C                          D1F P      01999010120000101        N                           
L6694001003ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM         Elbow socket ins use w/lock 38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L6694002004FABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL,                                                                                                                                                                                                                                         
L6694003004ELASTOMERIC OR EQUAL, FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                                 
L6695001003ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM         Elbow socket ins use w/o lck38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L6695002004FABRICATED FROM EXISTING MOLD OR PREFABRICATED, SOCKET INSERT, SILICONE GEL,                                                                                                                                                                                                                                         
L6695003004ELASTOMERIC OR EQUAL, NOT FOR USE WITH LOCKING MECHANISM                                                                                                                                                                                                                                                             
L6696001003ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM         Cus elbo skt in for con/atyp38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L6696002004FABRICATED SOCKET INSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE                                                                                                                                                                                                                                      
L6696003004GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL                                                                                                                                                                                                                                        
L6696004004ONLY (FOR OTHER THAN INITIAL, USE CODE L6694 OR L6695)                                                                                                                                                                                                                                                               
L6697001003ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM         Cus elbo skt in not con/atyp38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L6697002004FABRICATED SOCKET INSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC                                                                                                                                                                                                                                             
L6697003004AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING                                                                                                                                                                                                                                         
L6697004004MECHANISM, INITIAL ONLY (FOR OTHER THAN INITIAL, USE CODE L6694 OR L6695)                                                                                                                                                                                                                                            
L6698001003ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, LOCK           Below/above elbow lock mech 38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L6698002004MECHANISM, EXCLUDES SOCKET INSERT                                                                                                                                                                                                                                                                                    
L6700001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #3                           Terminal device model #3    38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6705001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #5                           Terminal device model #5    38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6710001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #5X                          Terminal device model #5x   38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6715001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #5XA                         Terminal device model #5xa  38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6720001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #6                           Terminal device model #6    38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6725001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #7                           Terminal device model #7    38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6730001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #7LO                         Terminal device model #7lo  38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6735001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #8                           Terminal device model #8    38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6740001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #8X                          Terminal device model #8x   38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6745001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #88X                         Terminal device model #88x  38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6750001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #10P                         Terminal device model #10p  38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6755001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #10X                         Terminal device model #10x  38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6765001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #12P                         Terminal device model #12p  38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6770001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #99X                         Terminal device model #99x  38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6775001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #555                         Terminal device model#555   38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6780001003TERMINAL DEVICE,  HOOK,  DORRANCE, OR EQUAL, MODEL #SS555                       Terminal device model #ss55538      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6790001003TERMINAL DEVICE,  HOOK-ACCU HOOK, OR EQUAL                                      Hooks-accu hook or equal    38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6795001003TERMINAL DEVICE, HOOK-2 LOAD, OR EQUAL                                          Hooks-2 load or equal       38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6800001003TERMINAL DEVICE, HOOK-APRL VC, OR EQUAL                                         Hooks-aprl vc or equal      38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6805001003TERMINAL DEVICE, MODIFIER WRIST FLEXION UNIT                                    Modifier wrist flexion unit 38      A                  2133                                                                               D                          D1F P      01985010119960101        N                           
L6806001003TERMINAL DEVICE, HOOK, TRS GRIP, GRIP III, VC, OR EQUAL                         Trs grip vc or equal        38      A                  2133                                                                               D                          D1F P      01988010119970101        N                           
L6807001003TERMINAL DEVICE, HOOK, GRIP I, GRIP II, VC, OR EQUAL                            Term device grip1/2 or equal38      A                  2133                                                                               D                          D1F P      01988010119970101        N                           
L6808001003TERMINAL DEVICE, HOOK, TRS ADEPT, INFANT OR CHILD, VC, OR EQUAL                 Term device infant or child 38      A                  2133                                                                               D                          D1F P      01988010119970101        N                           
L6809001003TERMINAL DEVICE, HOOK, TRS SUPER SPORT, PASSIVE                                 Trs super sport passive     38      A                  2133                                                                               D                          D1F P      01988010119960101        N                           
L6810001003TERMINAL DEVICE, PINCHER TOOL, OTTO BOCK OR EQUAL                               Pincher tool otto bock or eq38      A                  2133                                                                               D                          D1F P      01988010119960101        N                           
L6825001003TERMINAL DEVICE, HAND, DORRANCE, VO                                             Hands dorrance vo           38      A                  2133                                                                               D                          D1F P      01982010119960101        N                           
L6830001003TERMINAL DEVICE, HAND, APRL, VC                                                 Hand aprl vc                38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6835001003TERMINAL DEVICE, HAND, SIERRA, VO                                               Hand sierra vo              38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6840001003TERMINAL DEVICE, HAND, BECKER IMPERIAL                                          Hand becker imperial        38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6845001003TERMINAL DEVICE, HAND, BECKER LOCK GRIP                                         Hand becker lock grip       38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6850001003TERMINAL DEVICE, HAND, BECKER PLYLITE                                           Term dvc-hand becker plylite38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6855001003TERMINAL DEVICE, HAND, ROBIN-AIDS, VO                                           Hand robin-aids vo          38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6860001003TERMINAL DEVICE, HAND, ROBIN-AIDS, VO SOFT                                      Hand robin-aids vo soft     38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6865001003TERMINAL DEVICE, HAND, PASSIVE HAND                                             Hand passive hand           38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6867001003TERMINAL DEVICE, HAND, DETROIT INFANT HAND (MECHANICAL)                         Hand detroit infant hand    38      A                  2133                                                                               D                          D1F P      01988010119960101        N                           
L6868001003TERMINAL DEVICE, HAND, PASSIVE INFANT HAND, (STEEPER, HOSMER OR EQUAL)          Passive inf hand steeper/hos38      A                  2133                                                                               D                          D1F P      01988010119960101        N                           
L6870001003TERMINAL DEVICE, HAND, CHILD MITT                                               Hand child mitt             38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6872001003TERMINAL DEVICE, HAND, NYU CHILD HAND                                           Hand nyu child hand         38      A                  2133                                                                               D                          D1F P      01988010119960101        N                           
L6873001003TERMINAL DEVICE, HAND, MECHANICAL INFANT HAND, STEEPER OR EQUAL                 Hand mech inf steeper or equ38      A                  2133                                                                               D                          D1F P      01988010119960101        N                           
L6875001003TERMINAL DEVICE, HAND, BOCK, VC                                                 Hand bock vc                38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6880001003TERMINAL DEVICE, HAND, BOCK, VO                                                 Hand bock vo                38      A                  2133                                                                               D                          D1F P      01986010119960101        N                           
L6881001003AUTOMATIC GRASP FEATURE, ADDITION TO UPPER LIMB PROSTHETIC TERMINAL DEVICE      Autograsp feature ul term dv38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L6882001003MICROPROCESSOR CONTROL FEATURE, ADDITION TO UPPER LIMB PROSTHETIC TERMINAL      Microprocessor control uplmb38      A                  2133                                                                               D                          D1F P      02002010120020101        N                           
L6882002004DEVICE                                                                                                                                                                                                                                                                                                               
L6883001003REPLACEMENT SOCKET, BELOW ELBOW/WRIST DISARTICULATION, MOLDED TO PATIENT MODEL, Replc sockt below e/w disa  38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L6883002004FOR USE WITH OR WITHOUT EXTERNAL POWER                                                                                                                                                                                                                                                                               
L6884001003REPLACEMENT SOCKET, ABOVE ELBOW DISARTICULATION, MOLDED TO PATIENT MODEL, FOR   Replc sockt above elbow disa38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L6884002004USE WITH OR WITHOUT EXTERNAL POWER                                                                                                                                                                                                                                                                                   
L6885001003REPLACEMENT SOCKET, SHOULDER DISARTICULATION/INTERSCAPULAR THORACIC, MOLDED TO  Replc sockt shldr dis/interc38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L6885002004PATIENT MODEL, FOR USE WITH OR WITHOUT EXTERNAL POWER                                                                                                                                                                                                                                                                
L6890001003ADDITION TO UPPER EXTREMITY PROSTHESIS, GLOVE FOR TERMINAL DEVICE, ANY          Prefab glove for term device38      A                                                                                                     C                          D1F P      01986010120050101        N                           
L6890002004MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT                                                                                                                                                                                                                                                             
L6895001003ADDITION TO UPPER EXTREMITY PROSTHESIS, GLOVE FOR TERMINAL DEVICE, ANY          Custom glove for term device38      A                                                                                                     C                          D1F P      01986010120050101        N                           
L6895002004MATERIAL, CUSTOM FABRICATED                                                                                                                                                                                                                                                                                          
L6900001003HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH Hand restorat thumb/1 finger38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6900002004GLOVE, THUMB OR ONE FINGER REMAINING                                                                                                                                                                                                                                                                                 
L6905001003HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH Hand restoration multiple fi38      A                                                                                                     C                          D1F P      01986010119960101        N                           
L6905002004GLOVE, MULTIPLE FINGERS REMAINING                                                                                                                                                                                                                                                                                    
L6910001003HAND RESTORATION (CASTS, SHADING AND MEASUREMENTS INCLUDED), PARTIAL HAND, WITH Hand restoration no fingers 38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6910002004GLOVE, NO FINGERS REMAINING                                                                                                                                                                                                                                                                                          
L6915001003HAND RESTORATION (SHADING, AND MEASUREMENTS INCLUDED), REPLACEMENT GLOVE FOR    Hand restoration replacmnt g38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L6915002004ABOVE                                                                                                                                                                                                                                                                                                                
L6920001003WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE   Wrist disarticul switch ctrl38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6920002004FOREARM SHELL, OTTO BOCK OR EQUAL, SWITCH, CABLES, TWO BATTERIES AND ONE                                                                                                                                                                                                                                             
L6920003004CHARGER, SWITCH CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                           
L6925001003WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE   Wrist disart myoelectronic c38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6925002004FOREARM SHELL, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE                                                                                                                                                                                                                                          
L6925003004CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                    
L6930001003BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM     Below elbow switch control  38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6930002004SHELL, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH                                                                                                                                                                                                                                      
L6930003004CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                                           
L6935001003BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM     Below elbow myoelectronic ct38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6935002004SHELL, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER,                                                                                                                                                                                                                                         
L6935003004MYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                             
L6940001003ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL   Elbow disarticulation switch38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6940002004SHELL, OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO                                                                                                                                                                                                                                       
L6940003004BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                         
L6945001003ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL   Elbow disart myoelectronic c38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6945002004SHELL, OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES,                                                                                                                                                                                                                                       
L6945003004TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                              
L6950001003ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL,      Above elbow switch control  38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6950002004INTERNAL LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO                                                                                                                                                                                                                                              
L6950003004BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                         
L6955001003ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL,      Above elbow myoelectronic ct38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6955002004INTERNAL LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO                                                                                                                                                                                                                                          
L6955003004BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                  
L6960001003SHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE        Shldr disartic switch contro38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6960002004SHOULDER SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM,                                                                                                                                                                                                                                       
L6960003004OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH                                                                                                                                                                                                                                             
L6960004004CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                                           
L6965001003SHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE        Shldr disartic myoelectronic38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6965002004SHOULDER SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM,                                                                                                                                                                                                                                       
L6965003004OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER,                                                                                                                                                                                                                                                
L6965004004MYOELECTRONIC CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                             
L6970001003INTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER Interscapular-thor switch ct38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6970002004SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK                                                                                                                                                                                                                                      
L6970003004OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF                                                                                                                                                                                                                                            
L6970004004TERMINAL DEVICE                                                                                                                                                                                                                                                                                                      
L6975001003INTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER Interscap-thor myoelectronic38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L6975002004SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK                                                                                                                                                                                                                                      
L6975003004OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC                                                                                                                                                                                                                                            
L6975004004CONTROL OF TERMINAL DEVICE                                                                                                                                                                                                                                                                                           
L7010001003ELECTRONIC HAND, OTTO BOCK, STEEPER OR EQUAL, SWITCH CONTROLLED                 Hand otto back steeper/eq sw38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7015001003ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED     Hand sys teknik village swit38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7020001003ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, SWITCH CONTROLLED                       Electronic greifer switch ct38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7025001003ELECTRONIC HAND, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED               Electron hand myoelectronic 38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7030001003ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY     Hand sys teknik vill myoelec38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7030002004CONTROLLED                                                                                                                                                                                                                                                                                                           
L7035001003ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED            Electron greifer myoelectro 38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7040001003PREHENSILE ACTUATOR, HOSMER OR EQUAL, SWITCH CONTROLLED                         Prehensile actuator hosmer s38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7045001003ELECTRONIC HOOK, CHILD, MICHIGAN OR EQUAL, SWITCH CONTROLLED                    Electron hook child michigan38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7170001003ELECTRONIC ELBOW, HOSMER OR EQUAL, SWITCH CONTROLLED                            Electronic elbow hosmer swit38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7180001003ELECTRONIC ELBOW, MICROPROCESSOR SEQUENTIAL CONTROL OF ELBOW AND TERMINAL DEVICEElectronic elbow sequential 38      A                                                                                                     C                          D1F P      01988010120050101        N                           
L7181001003ELECTRONIC ELBOW, MICROPROCESSOR SIMULTANEOUS CONTROL OF ELBOW AND TERMINAL     Electronic elbo simultaneous38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L7181002004DEVICE                                                                                                                                                                                                                                                                                                               
L7185001003ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED       Electron elbow adolescent sw38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7186001003ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED            Electron elbow child switch 38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L7190001003ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY       Elbow adolescent myoelectron38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7190002004CONTROLLED                                                                                                                                                                                                                                                                                                           
L7191001003ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED Elbow child myoelectronic ct38      A                                                                                                     C                          D1F P      01989010119960101        N                           
L7260001003ELECTRONIC WRIST ROTATOR, OTTO BOCK OR EQUAL                                    Electron wrist rotator otto 38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7261001003ELECTRONIC WRIST ROTATOR, FOR UTAH ARM                                          Electron wrist rotator utah 38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7266001003SERVO CONTROL, STEEPER OR EQUAL                                                 Servo control steeper or equ38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7272001003ANALOGUE CONTROL, UNB OR EQUAL                                                  Analogue control unb or equa38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7274001003PROPORTIONAL CONTROL, 6-12 VOLT, LIBERTY, UTAH OR EQUAL                         Proportional ctl 12 volt uta38      A                                                                                                     C                          D1F P      01988010119970101        N                           
L7360001003SIX VOLT BATTERY, OTTO BOCK OR EQUAL, EACH                                      Six volt bat otto bock/eq ea38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7362001003BATTERY CHARGER, SIX VOLT, OTTO BOCK OR EQUAL                                   Battery chrgr six volt otto 38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7364001003TWELVE VOLT BATTERY, UTAH OR EQUAL, EACH                                        Twelve volt battery utah/equ38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7366001003BATTERY CHARGER, TWELVE VOLT, UTAH OR EQUAL                                     Battery chrgr 12 volt utah/e38      A                                                                                                     C                          D1F P      01988010119960101        N                           
L7367001003LITHIUM ION BATTERY, REPLACEMENT                                                Replacemnt lithium ionbatter38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L7368001003LITHIUM ION BATTERY CHARGER                                                     Lithium ion battery charger 38      A                                                                                                     C                          D1F P      02003010120030101        N                           
L7400001003ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/WRIST DISARTICULATION,      Add UE prost be/wd, ultlite 38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L7400002004ULTRALIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                
L7401001003ADDITION TO UPPER EXTREMITY PROSTHESIS, ABOVE ELBOW DISARTICULATION, ULTRALIGHT Add UE prost a/e ultlite mat38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L7401002004MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                                           
L7402001003ADDITION TO UPPER EXTREMITY PROSTHESIS, SHOULDER DISARTICULATION/INTERSCAPULAR  Add UE prost s/d ultlite mat38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L7402002004THORACIC, ULTRALIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)                                                                                                                                                                                                                                                      
L7403001003ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/WRIST DISARTICULATION,      Add UE prost b/e acrylic    38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L7403002004ACRYLIC MATERIAL                                                                                                                                                                                                                                                                                                     
L7404001003ADDITION TO UPPER EXTREMITY PROSTHESIS, ABOVE ELBOW DISARTICULATION, ACRYLIC    Add UE prost a/e acrylic    38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L7404002004MATERIAL                                                                                                                                                                                                                                                                                                             
L7405001003ADDITION TO UPPER EXTREMITY PROSTHESIS, SHOULDER DISARTICULATION/INTERSCAPULAR  Add UE prost s/d acrylic    38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L7405002004THORACIC, ACRYLIC MATERIAL                                                                                                                                                                                                                                                                                           
L7499001003UPPER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED                             Upper extremity prosthes NOS46      A                                                                                                     C                          D1F P      01985010119980101        N                           
L7500001003REPAIR OF PROSTHETIC DEVICE, HOURLY RATE (EXCLUDES V5335 REPAIR OF ORAL OR      Prosthetic dvc repair hourly46      A                  2100.4  2130D   2133                                                               D                          D1F P      01982010119960101        N                           
L7500002004LARYNGEAL PROSTHESIS OR ARTIFICIAL LARYNX)                                                                                                                                                                                                                                                                           
L7510001003REPAIR OF PROSTHETIC DEVICE, REPAIR OR REPLACE MINOR PARTS                      Prosthetic device repair rep46      A                  2100.4  2130D   2133                                                               D                          D1F P      01985010120030101        N                           
L7520001003REPAIR PROSTHETIC DEVICE, LABOR COMPONENT, PER 15 MINUTES                       Repair prosthesis per 15 min46      A                                                                                                     C                          D1F P      01997010120000101        N                           
L7600001003PROSTHETIC DONNING SLEEVE, ANY MATERIAL, EACH                                   Prosthetic donning sleeve   38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L7900001003MALE VACUUM ERECTION SYSTEM                                                     Male vacuum erection system 38      A                                                                                                     C                          D1F P      01997010120030101        N                           
L8000001003BREAST PROSTHESIS, MASTECTOMY BRA                                               Mastectomy bra              38      A                  2130 A                                                                             D                          D1F P      01986010119960101        N                           
L8001001003BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM,      Breast prosthesis bra & form38      A                  2130A                                                                              D                          D1F P      02002010120020101        N                           
L8001002004UNILATERAL                                                                                                                                                                                                                                                                                                           
L8002001003BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM,      Brst prsth bra & bilat form 38      A                  2130A                                                                              D                          D1F P      02002010120020101        N                           
L8002002004BILATERAL                                                                                                                                                                                                                                                                                                            
L8010001003BREAST PROSTHESIS, MASTECTOMY SLEEVE                                            Mastectomy sleeve           00      9                  2130 A                                                                             D                          D1F P      01986010120050401        P                           
L8015001003EXTERNAL BREAST PROSTHESIS GARMENT, WITH MASTECTOMY FORM, POST MASTECTOMY       Ext breastprosthesis garment38      A                  2130                                                                               D                          D1F P      01999010119990101        N                           
L8020001003BREAST PROSTHESIS, MASTECTOMY FORM                                              Mastectomy form             38      A                  2130 A                                                                             D                          D1F P      01986010119960101        N                           
L8030001003BREAST PROSTHESIS, SILICONE OR EQUAL                                            Breast prosthesis silicone/e38      A                  2130 A                                                                             D                          D1F P      01989010119960101        N                           
L8035001003CUSTOM BREAST PROSTHESIS, POST MASTECTOMY, MOLDED TO PATIENT MODEL              Custom breast prosthesis    38      A                  2130                                                                               D                          D1F P      01999010119990101        N                           
L8039001003BREAST PROSTHESIS, NOT OTHERWISE SPECIFIED                                      Breast prosthesis NOS       46      A                                                                                                     C                          D1F P      01998010119980101        N                           
L8040001003NASAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                   Nasal prosthesis            38      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8041001003MIDFACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                               Midfacial prosthesis        38      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8042001003ORBITAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                                 Orbital prosthesis          38      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8043001003UPPER FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                            Upper facial prosthesis     38      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8044001003HEMI-FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                             Hemi-facial prosthesis      38      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8045001003AURICULAR PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                               Auricular prosthesis        38      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8046001003PARTIAL FACIAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                          Partial facial prosthesis   38      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8047001003NASAL SEPTAL PROSTHESIS, PROVIDED BY A NON-PHYSICIAN                            Nasal septal prosthesis     38      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8048001003UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT, PROVIDED BY A NON-PHYSICIAN    Unspec maxillofacial prosth 46      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8049001003REPAIR OR MODIFICATION OF MAXILLOFACIAL PROSTHESIS, LABOR COMPONENT, 15 MINUTE  Repair maxillofacial prosth 46      A                                                                                                     C                          D1F P      02001010120010101        N                           
L8049002004INCREMENTS, PROVIDED BY A NON-PHYSICIAN                                                                                                                                                                                                                                                                              
L8100001003GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH                     Compression stocking BK18-3000      960-9              2133                                                      A6530                    M                      0072D1F P      0198601012006010120051231D                           
L8110001003GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH                     Compression stocking BK30-4035      A                  2079                                                      A6531                    D                      0072D1A PS     0198601012006010120051231D                           
L8120001003GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH                     Compression stocking BK40-5035      A                  2079                                                      A6532                    D                      0072D1A PS     0198601012006010120051231D                           
L8130001003GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH                   Gc stocking thighlngth 18-3000      960-9              2133                                                      A6533                    M                      0072D1F P      0198601012006010120051231D                           
L8140001003GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH                   Gc stocking thighlngth 30-4000      960-9              2133                                                      A6534                    M                      0072D1F P      0198601012006010120051231D                           
L8150001003GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH                   Gc stocking thighlngth 40-5000      960-9              2133                                                      A6535                    M                      0072D1F P      0198601012006010120051231D                           
L8160001003GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH         Gc stocking full lngth 18-3000      960-9              2133                                                      A6536                    M                      0072D1F P      0198601012006010120051231D                           
L8170001003GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH         Gc stocking full lngth 30-4000      960-9              2133                                                      A6537                    M                      0072D1F P      0198601012006010120051231D                           
L8180001003GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH         Gc stocking full lngth 40-5000      960-9              2133                                                      A6538                    M                      0072D1F P      0198601012006010120051231D                           
L8190001003GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH                   Gc stocking waistlngth 18-3000      960-9              2133                                                      A6539                    M                      0072D1F P      0198601012006010120051231D                           
L8195001003GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH                   Gc stocking waistlngth 30-4000      960-9              2133                                                      A6540                    M                      0072D1F P      0199901012006010120051231D                           
L8200001003GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH                   Gc stocking waistlngth 40-5000      960-9              2133                                                      A6541                    M                      0072D1F P      0198601012006010120051231D                           
L8210001003GRADIENT COMPRESSION  STOCKING, CUSTOM MADE                                     Gc stocking custom made     00      960-9              2133                                                      A6542                    M                          D1F P      0198601012006010120051231D                           
L8220001003GRADIENT COMPRESSION STOCKING, LYMPHEDEMA                                       Gc stocking lymphedema      00      960-9              2133                                                      A6543                    M                          D1F P      0198601012006010120051231D                           
L8230001003GRADIENT COMPRESSION STOCKING, GARTER BELT                                      Gc stocking garter belt     00      960-9              2133                                                      A6544                    M                          D1F P      0198601012006010120051231D                           
L8239001003GRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED                          G compression stocking  NOS 46      A                                                                            A6549                    C                          D1F P      0199801012006010120051231D                           
L8300001003TRUSS, SINGLE WITH STANDARD PAD                                                 Truss single w/ standard pad38      A70-1  70-2        2133                                                                               D                          D1F P      01986010119960101        N                           
L8310001003TRUSS, DOUBLE WITH STANDARD PADS                                                Truss double w/ standard pad38      A70-1  70-2        2133                                                                               D                          D1F P      01986010119960101        N                           
L8320001003TRUSS, ADDITION TO STANDARD PAD, WATER PAD                                      Truss addition to std pad wa38      A70-1  70-2        2133                                                                               D                          D1F P      01986010119960101        N                           
L8330001003TRUSS, ADDITION TO STANDARD PAD, SCROTAL PAD                                    Truss add to std pad scrotal38      A70-1  70-2        2133                                                                               D                          D1F P      01986010119960101        N                           
L8400001003PROSTHETIC SHEATH, BELOW KNEE, EACH                                             Sheath below knee           38      A                  2133                                                                               D                          D1F P      01982010119960101        N                           
L8410001003PROSTHETIC SHEATH, ABOVE KNEE, EACH                                             Sheath above knee           38      A                  2133                                                                               D                          D1F P      01982010119960101        N                           
L8415001003PROSTHETIC SHEATH, UPPER LIMB, EACH                                             Sheath upper limb           38      A                  2133                                                                               D                          D1F P      01988010119960101        N                           
L8417001003PROSTHETIC SHEATH/SOCK, INCLUDING A GEL CUSHION LAYER, BELOW KNEE OR ABOVE      Pros sheath/sock w gel cushn38      A                                                                                                     C                          D1F P      01997010119970101        N                           
L8417002004KNEE, EACH                                                                                                                                                                                                                                                                                                           
L8420001003PROSTHETIC SOCK, MULTIPLE PLY, BELOW KNEE, EACH                                 Prosthetic sock multi ply BK38      A                  2133                                                                               D                          D1F P      01982010119990101        N                           
L8430001003PROSTHETIC SOCK, MULTIPLE PLY, ABOVE KNEE, EACH                                 Prosthetic sock multi ply AK38      A                  2133                                                                               D                          D1F P      01982010119990101        N                           
L8435001003PROSTHETIC SOCK, MULTIPLE  PLY, UPPER LIMB, EACH                                Pros sock multi ply upper lm38      A                  2133                                                                               D                          D1F P      01988010120000101        N                           
L8440001003PROSTHETIC SHRINKER, BELOW KNEE, EACH                                           Shrinker below knee         38      A                  2133                                                                               D                          D1F P      01982010119960101        N                           
L8460001003PROSTHETIC SHRINKER, ABOVE KNEE, EACH                                           Shrinker above knee         38      A                  2133                                                                               D                          D1F P      01982010119960101        N                           
L8465001003PROSTHETIC SHRINKER, UPPER LIMB, EACH                                           Shrinker upper limb         38      A                  2133                                                                               D                          D1F P      01988010119960101        N                           
L8470001003PROSTHETIC SOCK, SINGLE PLY, FITTING, BELOW KNEE, EACH                          Pros sock single ply BK     38      A                  2133                                                                               D                          D1F P      01982010119990101        N                           
L8480001003PROSTHETIC SOCK, SINGLE PLY, FITTING, ABOVE KNEE, EACH                          Pros sock single ply AK     38      A                  2133                                                                               D                          D1F P      01982010119990101        N                           
L8485001003PROSTHETIC SOCK, SINGLE PLY, FITTING, UPPER LIMB, EACH                          Pros sock single ply upper l38      A                  2133                                                                               D                          D1F P      01994010119990101        N                           
L8490001003ADDITION TO PROSTHETIC SHEATH/SOCK, AIR SEAL SUCTION RETENTION SYSTEM           Air seal suction reten systm38      A                                                                                                     C                          D1F P      0199401012005010120041231N                           
L8499001003UNLISTED PROCEDURE FOR MISCELLANEOUS PROSTHETIC SERVICES                        Unlisted misc prosthetic ser46      A                                                                                                     C                          D1F P      01982010120020101        N                           
L8500001003ARTIFICIAL LARYNX, ANY TYPE                                                     Artificial larynx           38      A65-5              2130                                                                               D                          D1F P      01990010119960101        N                           
L8501001003TRACHEOSTOMY SPEAKING VALVE                                                     Tracheostomy speaking valve 38      A65-16                                                                                                D                          D1F P      01990010119960101        N                           
L8505001003ARTIFICIAL LARYNX REPLACEMENT BATTERY / ACCESSORY, ANY TYPE                     Artificial larynx, accessory46      A                                                                                                     C                          D1F P      02002010120020101        N                           
L8507001003TRACHEO-ESOPHAGEAL VOICE PROSTHESIS, PATIENT INSERTED, ANY TYPE, EACH           Trach-esoph voice pros pt in38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L8509001003TRACHEO-ESOPHAGEAL VOICE PROSTHESIS, INSERTED BY A LICENSED HEALTH CARE         Trach-esoph voice pros md in38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L8509002004PROVIDER, ANY TYPE                                                                                                                                                                                                                                                                                                   
L8510001003VOICE AMPLIFIER                                                                 Voice amplifier             38      A65-5                                                                                                 D                          D1F P      02002010120020101        N                           
L8511001003INSERT FOR INDWELLING TRACHEOESOPHAGEAL PROSTHESIS, WITH OR WITHOUT VALVE,      Indwelling trach insert     38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L8511002004REPLACEMENT ONLY, EACH                                                                                                                                                                                                                                                                                               
L8512001003GELATIN CAPSULES OR EQUIVALENT, FOR USE WITH TRACHEOESOPHAGEAL VOICE            Gel cap for trach voice pros38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L8512002004PROSTHESIS, REPLACEMENT ONLY, PER 10                                                                                                                                                                                                                                                                                 
L8513001003CLEANING DEVICE USED WITH TRACHEOESOPHAGEAL VOICE PROSTHESIS, PIPET, BRUSH, OR  Trach pros cleaning device  38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L8513002004EQUAL, REPLACEMENT ONLY, EACH                                                                                                                                                                                                                                                                                        
L8514001003TRACHEOESOPHAGEAL PUNCTURE DILATOR, REPLACEMENT ONLY, EACH                      Repl trach puncture dilator 38      A                                                                                                     C                          D1F P      02004010120040101        N                           
L8515001003GELATIN CAPSULE, APPLICATION DEVICE FOR USE WITH TRACHEOESOPHAGEAL VOICE        Gel cap app device for trach37      A                                                                                                     C                          D1F P      02005010120050101        N                           
L8515002004PROSTHESIS, EACH                                                                                                                                                                                                                                                                                                     
L8600001003IMPLANTABLE BREAST PROSTHESIS, SILICONE OR EQUAL                                Implant breast silicone/eq  38      A35-47             2130                                                                               D                          D1F P      01992010119971001        N                           
L8603001003INJECTABLE BULKING AGENT, COLLAGEN IMPLANT, URINARY TRACT, 2.5 ML SYRINGE,      Collagen imp urinary 2.5 ml 38      A65.9                                                                                                 D                          D1F P      01995010120010101        N                           
L8603002004INCLUDES SHIPPING AND NECESSARY SUPPLIES                                                                                                                                                                                                                                                                             
L8606001003INJECTABLE BULKING AGENT, SYNTHETIC IMPLANT, URINARY TRACT, 1 ML SYRINGE,       Synthetic implnt urinary 1ml38      A65.9                                                                                                 D                          D1F P      02001010120010101        N                           
L8606002004INCLUDES SHIPPING AND NECESSARY SUPPLIES                                                                                                                                                                                                                                                                             
L8609001003ARTIFICIAL CORNEA                                                               Artificial cornea           38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L8610001003OCULAR IMPLANT                                                                  Ocular implant              38      A                  2130                                                                               D                          D1F P      01992010119971001        N                           
L8612001003AQUEOUS SHUNT                                                                   Aqueous shunt prosthesis    38      A                  2130                                                      Q0074                    D                          D1F P      01992010119971001        N                           
L8613001003OSSICULA IMPLANT                                                                Ossicular implant           38      A                  2130                                                                               D                          D1F P      01992010119971001        N                           
L8614001003COCHLEAR DEVICE/SYSTEM                                                          Cochlear device/system      38      A65-14             2130                                                                               D                          D1F P      01992010119960916        N                           
L8615001003HEADSET/HEADPIECE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT             Coch implant headset replace38      A65-14                                                                                                D                          D1F P      02005010120050101        N                           
L8616001003MICROPHONE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT                    Coch implant microphone repl38      A65-14                                                                                                D                          D1F P      02005010120050101        N                           
L8617001003TRANSMITTING COIL FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT             Coch implant trans coil repl38      A65-14                                                                                                D                          D1F P      02005010120050101        N                           
L8618001003TRANSMITTER CABLE FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT             Coch implant tran cable repl38      A65-14                                                                                                D                          D1F P      02005010120050101        N                           
L8619001003COCHLEAR IMPLANT EXTERNAL SPEECH PROCESSOR, REPLACEMENT                         Replace cochlear processor  38      A65-14                                                                                                D                          D1F P      01996010119960916        N                           
L8620001003LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH     Repl lithium ion battery    00      9                                                                                                     I                          D1F P      0200501012006010120051231D                           
L8621001003ZINC AIR BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH        Repl zinc air battery       38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L8622001003ALKALINE BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, ANY SIZE, REPLACEMENT,   Repl alkaline battery       38      A                                                                                                     C                          D1F P      02005010120050101        N                           
L8622002004EACH                                                                                                                                                                                                                                                                                                                 
L8623001003LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR,      Lith ion batt CID,non-earlvl38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L8623002004OTHER THAN EAR LEVEL, REPLACEMENT, EACH                                                                                                                                                                                                                                                                              
L8624001003LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, EAR  Lith ion batt CID, ear level38      A                                                                                                     C                          D1F P      02006010120060101        A                           
L8624002004LEVEL, REPLACEMENT, EACH                                                                                                                                                                                                                                                                                             
L8630001003METACARPOPHALANGEAL JOINT IMPLANT                                               Metacarpophalangeal implant 38      A                  2130                                                                               D                          D1F P      01992010119971001        N                           
L8631001003METACARPAL PHALANGEAL JOINT REPLACEMENT, TWO OR MORE PIECES, METAL (E.G.,       MCP joint repl 2 pc or more 38      A                  2130                                                                               D                          D1F P      02004010120040101        N                           
L8631002004STAINLESS STEEL OR COBALT CHROME), CERAMIC-LIKE MATERIAL (E.G., PYROCARBON),                                                                                                                                                                                                                                         
L8631003004FOR SURGICAL IMPLANTATION (ALL SIZES, INCLUDES ENTIRE SYSTEM)                                                                                                                                                                                                                                                        
L8641001003METATARSAL JOINT IMPLANT                                                        Metatarsal joint implant    38      A                  2130                                                                               D                          D1F P      01992010119971001        N                           
L8642001003HALLUX IMPLANT                                                                  Hallux implant              38      A                  2130                                                      Q0073                    D                          D1F P      01992010119971001        N                           
L8658001003INTERPHALANGEAL JOINT SPACER, SILICONE OR EQUAL, EACH                           Interphalangeal joint spacer38      A                  2130                                                                               D                          D1F P      01992010120040101        N                           
L8659001003INTERPHALANGEAL FINGER JOINT REPLACEMENT, 2 OR MORE PIECES, METAL (E.G.,        Interphalangeal joint repl  38      A                  2130                                                                               D                          D1F P      02004010120040101        N                           
L8659002004STAINLESS STEEL OR COBALT CHROME), CERAMIC-LIKE MATERIAL (E.G., PYROCARBON) FOR                                                                                                                                                                                                                                      
L8659003004SURGICAL IMPLANTATION, ANY SIZE                                                                                                                                                                                                                                                                                      
L8670001003VASCULAR GRAFT MATERIAL, SYNTHETIC, IMPLANT                                     Vascular graft, synthetic   38      A                  2130                                                                               D                          D1F P      01992010119971001        N                           
L8680001003IMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH                                     Implt neurostim elctr each  38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8681001003PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE             Pt prgrm for implt neurostim38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8681002004NEUROSTIMULATOR PULSE GENERATOR                                                                                                                                                                                                                                                                                      
L8682001003IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER                             Implt neurostim radiofq rec 38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8683001003RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR  Radiofq trsmtr for implt neu38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8683002004RADIOFREQUENCY RECEIVER                                                                                                                                                                                                                                                                                              
L8684001003RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT      Radiof trsmtr implt scrl neu38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8684002004NEUROSTIMULATOR RECEIVER FOR BOWEL AND BLADDER MANAGEMENT, REPLACEMENT                                                                                                                                                                                                                                               
L8685001003IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, SINGLE ARRAY, RECHARGEABLE,        Implt nrostm pls gen sng rec38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8685002004INCLUDES EXTENSION                                                                                                                                                                                                                                                                                                   
L8686001003IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, SINGLE ARRAY, NON-RECHARGEABLE,    Implt nrostm pls gen sng non38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8686002004INCLUDES EXTENSION                                                                                                                                                                                                                                                                                                   
L8687001003IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, DUAL ARRAY, RECHARGEABLE, INCLUDES Implt nrostm pls gen dua rec38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8687002004EXTENSION                                                                                                                                                                                                                                                                                                            
L8688001003IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, DUAL ARRAY, NON-RECHARGEABLE,      Implt nrostm pls gen dua non38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8688002004INCLUDES EXTENSION                                                                                                                                                                                                                                                                                                   
L8689001003EXTERNAL RECHARGING SYSTEM FOR IMPLANTED NEUROSTIMULATOR, REPLACEMENT ONLY      External recharging system  38      A65-8                                                                                                 D                          D1F P      02006010120060101        A                           
L8699001003PROSTHETIC IMPLANT, NOT OTHERWISE SPECIFIED                                     Prosthetic implant NOS      46      A                                                                                                     C                          D1F P      01998010119980101        N                           
L9900001003ORTHOTIC AND PROSTHETIC SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER  O&P supply/accessory/service46      A                                                                                                     C                          D1F P      02000010120000101        N                           
L9900002004HCPCS "L" CODE                                                                                                                                                                                                                                                                                                       
M0064001003BRIEF OFFICE VISIT FOR THE SOLE PURPOSE OF MONITORING OR CHANGING DRUG          Visit for drug monitoring   11      A                  2476.3                                                                             D                          M5B 1      01992010119960101        N                           
M0064002004PRESCRIPTIONS USED IN THE TREATMENT OF MENTAL PSYCHONEUROTIC AND PERSONALITY                                                                                                                                                                                                                                         
M0064003004DISORDERS                                                                                                                                                                                                                                                                                                            
M0075001003CELLULAR THERAPY                                                                Cellular therapy            00      935-5                                                                                                 M                          Y2  1      01986010119960101        N                           
M0076001003PROLOTHERAPY                                                                    Prolotherapy                00      935-13                                                                                                M                          Y2  1      01986010119960101        N                           
M0100001003INTRAGASTRIC HYPOTHERMIA USING GASTRIC FREEZING                                 Intragastric hypothermia    00      935-65                                                                                                M                          P1G 1      01986010120040101        N                           
M0300001003IV CHELATION THERAPY (CHEMICAL ENDARTERECTOMY)                                  IV chelationtherapy         00      935-64                                                                                                M                          Y2  1      01986010119960101        N                           
M0301001003FABRIC WRAPPING OF ABDOMINAL ANEURYSM                                           Fabric wrapping of aneurysm 00      935-34                                                                                                M                          P1G 2      01986010120040101        N                           
P2028001003CEPHALIN FLOCULATION, BLOOD                                                     Cephalin floculation test   57      A50-34                                                                                                D                          T1H 5      01986010119900101        N                           
P2029001003CONGO RED, BLOOD                                                                Congo red blood test        57      A50-34                                                                                                D                          T1H 5      01986010119900101        N                           
P2031001003HAIR ANALYSIS (EXCLUDING ARSENIC)                                               Hair analysis               00      950-24                                                                                                M                          T1H 5      01986010119890101        N                           
P2033001003THYMOL TURBIDITY, BLOOD                                                         Blood thymol turbidity      57      A50-34                                                                                                D                          T1H 5      01986010119900101        N                           
P2038001003MUCOPROTEIN, BLOOD (SEROMUCOID) (MEDICAL NECESSITY PROCEDURE)                   Blood mucoprotein           21      A50-34                                                                                                D                          T1H 5      01986010119930101        N                           
P3000001003SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS, BY       Screen pap by tech w md supv21      A50-20                                               630                                              D                      0045T1H 5      01992010119950101        N                           
P3000002004TECHNICIAN UNDER PHYSICIAN SUPERVISION                                                                                                                                                                                                                                                                               
P3001001003SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS,          Screening pap smear by phys 1121    C50-20                                               630                                              D                      0045T1G 5      01992010120020101        N                           
P3001002004REQUIRING INTERPRETATION BY PHYSICIAN                                                                                                                                                                                                                                                                                
P7001001003CULTURE, BACTERIAL, URINE; QUANTITATIVE, SENSITIVITY STUDY                      Culture bacterial urine     00      9                                                    110                     CPT                      I                          T1H 5      01986010119960101        N                           
P9010001003BLOOD (WHOLE), FOR TRANSFUSION, PER UNIT                                        Whole blood for transfusion 52      A                  2455A                                                                              D                          T1H 0      01987010119870101        N                           
P9011001003BLOOD (SPLIT UNIT), SPECIFY AMOUNT                                              Blood split unit            52      A                  2455A                                                                              D                          T1H 0      01987010120010101        N                           
P9012001003CRYOPRECIPITATE, EACH UNIT                                                      Cryoprecipitate each unit   52      A                  2455 B                                                                             D                          T1H 9      01987010120010101        N                           
P9016001003RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT                                  RBC leukocytes reduced      52      A                  2455 B                                                                             D                          T1H 0      01987010120010101        N                           
P9017001003FRESH FROZEN PLASMA (SINGLE DONOR), FROZEN WITHIN 8 HOURS OF COLLECTION, EACH   Plasma 1 donor frz w/in 8 hr52      A                  2455 B                                                                             D                          T1H 9      01987010120040101        N                           
P9017002004UNIT                                                                                                                                                                                                                                                                                                                 
P9019001003PLATELETS, EACH UNIT                                                            Platelets, each unit        52      A                  2455 B                                                                             D                          T1H 9      01987010120010101        N                           
P9020001003PLATELET RICH PLASMA, EACH UNIT                                                 Plaelet rich plasma unit    52      A                  2455 B                                                                             D                          T1H 9      01987010120010101        N                           
P9021001003RED BLOOD CELLS, EACH UNIT                                                      Red blood cells unit        52      A                  2455A                                                                              D                          T1H 0      01987010120010101        N                           
P9022001003RED BLOOD CELLS, WASHED, EACH UNIT                                              Washed red blood cells unit 52      A                  2455A                                                                              D                          T1H 0      01987010119870101        N                           
P9023001003PLASMA, POOLED MULTIPLE DONOR, SOLVENT/DETERGENT TREATED, FROZEN, EACH UNIT     Frozen plasma, pooled, sd   52      A                  2455 B                                                                             D                          T1H 9      02000010120010101        N                           
P9031001003PLATELETS, LEUKOCYTES REDUCED, EACH UNIT                                        Platelets leukocytes reduced52      A                  2455                                                                               D                          T1H 9      02001010120010101        N                           
P9032001003PLATELETS, IRRADIATED, EACH UNIT                                                Platelets, irradiated       52      A                  2455                                                                               D                          T1H 9      02001010120010101        N                           
P9033001003PLATELETS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT                            Platelets leukoreduced irrad52      A                  2455                                                                               D                          T1H 9      02001010120010101        N                           
P9034001003PLATELETS, PHERESIS, EACH UNIT                                                  Platelets, pheresis         52      A                  2455                                                                               D                          T1H 9      02001010120010101        N                           
P9035001003PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT                              Platelet pheres leukoreduced52      A                  2455                                                                               D                          T1H 9      02001010120010101        N                           
P9036001003PLATELETS, PHERESIS, IRRADIATED, EACH UNIT                                      Platelet pheresis irradiated52      A                  2455                                                                               D                          T1H 9      02001010120010101        N                           
P9037001003PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT                  Plate pheres leukoredu irrad52      A                  2455                                                                               D                          T1H 9      02001010120010101        N                           
P9038001003RED BLOOD CELLS, IRRADIATED, EACH UNIT                                          RBC irradiated              52      A                  2455                                                                               D                          T1H 0      02001010120010101        N                           
P9039001003RED BLOOD CELLS, DEGLYCEROLIZED, EACH UNIT                                      RBC deglycerolized          52      A                  2455                                                                               D                          T1H 0      02001010120010101        N                           
P9040001003RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT                      RBC leukoreduced irradiated 52      A                  2455                                                                               D                          T1H 0      02001010120010101        N                           
P9041001003INFUSION, ALBUMIN (HUMAN), 5%, 50 ML                                            Albumin (human),5%, 50ml    52      A                                                                                                     C                          T1H 9      02001010120010101        N                           
P9043001003INFUSION, PLASMA PROTEIN FRACTION (HUMAN), 5%, 50 ML                            Plasma protein fract,5%,50ml52      A                  2455B                                                                              D                          T1H 9      02001010120010101        N                           
P9044001003PLASMA, CRYOPRECIPITATE REDUCED, EACH UNIT                                      Cryoprecipitatereducedplasma52      A                  2455.B                                                                             D                          T1H 9      02001010120010101        N                           
P9045001003INFUSION, ALBUMIN (HUMAN), 5%, 250 ML                                           Albumin (human), 5%, 250 ml 52      A                                                                                                     C                          Y2  9      02002010120020101        N                           
P9046001003INFUSION, ALBUMIN (HUMAN), 25%, 20 ML                                           Albumin (human), 25%, 20 ml 52      A                                                                                                     C                          Y2  9      02002010120020101        N                           
P9047001003INFUSION, ALBUMIN (HUMAN), 25%, 50 ML                                           Albumin (human), 25%, 50ml  52      A                                                                                                     C                          Y2  9      02002010120020101        N                           
P9048001003INFUSION, PLASMA PROTEIN FRACTION (HUMAN), 5%, 250ML                            Plasmaprotein fract,5%,250ml52      A                                                                                                     C                          Y2  9      02002010120020101        N                           
P9050001003GRANULOCYTES, PHERESIS, EACH UNIT                                               Granulocytes, pheresis unit 52      A                                                                                                     C                          Z2  9      02002010120020101        N                           
P9051001003WHOLE BLOOD OR RED BLOOD CELLS, LEUKOCYTES REDUCED, CMV-NEGATIVE, EACH UNIT     Blood, l/r, cmv-neg         52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N                           
P9052001003PLATELETS, HLA-MATCHED LEUKOCYTES REDUCED, APHERESIS/PHERESIS, EACH UNIT        Platelets, hla-m, l/r, unit 52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N                           
P9053001003PLATELETS, PHERESIS, LEUKOCYTES REDUCED, CMV-NEGATIVE, IRRADIATED, EACH UNIT    Plt, pher, l/r cmv-neg, irr 52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N                           
P9054001003WHOLE BLOOD OR RED BLOOD CELLS, LEUKOCYTES REDUCED, FROZEN, DEGLYCEROL, WASHED, Blood, l/r, froz/degly/wash 52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N                           
P9054002004EACH UNIT                                                                                                                                                                                                                                                                                                            
P9055001003PLATELETS, LEUKOCYTES REDUCED, CMV-NEGATIVE, APHERESIS/PHERESIS, EACH UNIT      Plt, aph/pher, l/r, cmv-neg 52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N                           
P9056001003WHOLE BLOOD, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT                          Blood, l/r, irradiated      52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N                           
P9057001003RED BLOOD CELLS, FROZEN/DEGLYCEROLIZED/WASHED, LEUKOCYTES REDUCED, IRRADIATED,  RBC, frz/deg/wsh, l/r, irrad52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N                           
P9057002004EACH UNIT                                                                                                                                                                                                                                                                                                            
P9058001003RED BLOOD CELLS, LEUKOCYTES REDUCED, CMV-NEGATIVE, IRRADIATED, EACH UNIT        RBC, l/r, cmv-neg, irrad    52      A                                          1833T                                                      D                          T1H 0      02004010120040101        N                           
P9059001003FRESH FROZEN PLASMA BETWEEN 8-24 HOURS OF COLLECTION, EACH UNIT                 Plasma, frz between 8-24hour52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N                           
P9060001003FRESH FROZEN PLASMA, DONOR RETESTED, EACH UNIT                                  Fr frz plasma donor retested52      A                                          1833T                                                      D                          T1H 9      02004010120040101        N                           
P9603001003TRAVEL ALLOWANCE ONE WAY IN CONNECTION WITH MEDICALLY NECESSARY LABORATORY      One-way allow prorated miles22      A                  51141K                                                                             D                      0039Y2  5      01987010119920101        N                           
P9603002004SPECIMEN COLLECTION DRAWN FROM HOME BOUND OR NURSING HOME BOUND PATIENT;                                                                                                                                                                                                                                             
P9603003004PRORATED MILES ACTUALLY TRAVELLED.                                                                                                                                                                                                                                                                                   
P9604001003TRAVEL ALLOWANCE ONE WAY IN CONNECTION WITH MEDICALLY NECESSARY LABORATORY      One-way allow prorated trip 22      A                  51141K                                                                             D                      0039Y2  5      01987010119920101        N                           
P9604002004SPECIMEN COLLECTION DRAWN FROM HOME BOUND OR NURSING HOME BOUND PATIENT;                                                                                                                                                                                                                                             
P9604003004PRORATED TRIP CHARGE.                                                                                                                                                                                                                                                                                                
P9612001003CATHETERIZATION FOR COLLECTION OF SPECIMEN, SINGLE PATIENT, ALL PLACES OF       Catheterize for urine spec  57      A                  5114.1D                                                                            D                          T1H 5      01999010119990101        N                           
P9612002004SERVICE                                                                                                                                                                                                                                                                                                              
P9615001003CATHETERIZATION FOR COLLECTION OF SPECIMEN (S) (MULTIPLE PATIENTS)              Urine specimen collect mult 57      A                  51141D                                                                             D                      0040T1H 5      01985010119920101        N                           
Q0035001003CARDIOKYMOGRAPHY                                                                Cardiokymography            11      A50-50                                                                                                D                          T2D 5      01989010119910101        N                           
Q0081001003INFUSION THERAPY, USING OTHER THAN CHEMOTHERAPEUTIC DRUGS, PER VISIT            Infusion ther other than che00      960-14                                                                                                D                      0041P6C 1      01992010119960101        N                           
Q0083001003CHEMOTHERAPY ADMINISTRATION BY OTHER THAN INFUSION TECHNIQUE ONLY (EG           Chemo by other than infusion00      9                                                                                                     C                      0041O1D 1      01992010119960101        N                           
Q0083002004SUBCUTANEOUS, INTRAMUSCULAR, PUSH), PER VISIT                                                                                                                                                                                                                                                                        
Q0084001003CHEMOTHERAPY ADMINISTRATION BY INFUSION TECHNIQUE ONLY, PER VISIT               Chemotherapy by infusion    00      960-14                                                                                                D                      0041O1D 1      01992010119960101        N                           
Q0085001003CHEMOTHERAPY ADMINISTRATION BY BOTH INFUSION TECHNIQUE AND OTHER TECHIQUE(S)    Chemo by both infusion and o00      9                                                                                                     C                      0041O1D 1      01992010119960101        N                           
Q0085002004(EG SUBCUTANEOUS, INTRAMUSCULAR, PUSH), PER VISIT                                                                                                                                                                                                                                                                    
Q0086001003PHYSICAL THERAPY EVALUATION/TREATMENT, PER VISIT                                Physical therapy evaluation/00      9                  2210                                                                               D                      0049Z2  9      0199201012004010120031231N                           
Q0091001003SCREENING PAPANICOLAOU SMEAR; OBTAINING, PREPARING AND CONVEYANCE OF CERVICAL   Obtaining screen pap smear  11      A50-20                                                                                                D                          P6C 1      01992010119960701        N                           
Q0091002004OR VAGINAL SMEAR TO LABORATORY                                                                                                                                                                                                                                                                                       
Q0092001003SET-UP PORTABLE X-RAY EQUIPMENT                                                 Set up port xray equipment  11      A                  2070.4                                                                             D                          I1F 4      01993010119960101        N                           
Q0111001003WET MOUNTS, INCLUDING PREPARATIONS OF VAGINAL, CERVICAL OR SKIN SPECIMENS       Wet mounts/ w preparations  21      A                                                    110120130                                        C                          T1H 5      01994010119940101        N                           
Q0112001003ALL POTASSIUM HYDROXIDE (KOH) PREPARATIONS                                      Potassium hydroxide preps   21      A                                                    120                                              C                          T1H 5      01994010119940101        N                           
Q0113001003PINWORM EXAMINATIONS                                                            Pinworm examinations        21      A                                                    130                                              C                          T1H 5      01994010119940101        N                           
Q0114001003FERN TEST                                                                       Fern test                   21      A                                                    310                                              C                          T1H 5      01994010119940101        N                           
Q0115001003POST-COITAL DIRECT, QUALITATIVE EXAMINATIONS OF VAGINAL OR CERVICAL MUCOUS      Post-coital mucous exam     21      A                                                    400                                              C                          T1H 5      01994010119940101        N                           
Q0136001003INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000 UNITS                    Non esrd epoetin alpha inj  51      A                  2049                                                      J0885                    D                          O1E 9      0200012312006010120051231D                           
Q0137001003INJECTION, DARBEPOETIN ALFA, 1 MCG (NON-ESRD USE)                               Darbepoetin alfa, non-esrd  57      A                  4273.1                                                    J0881                    D                          O1E 1L     0200401012006010120051231D                           
Q0144001003AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM                           Azithromycin dihydrate, oral00      9                                                                                                     M                      0054O1E 1      01996070120020701        N                           
Q0163001003DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION           Diphenhydramine HCl 50mg    51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0163002004ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q0163003004AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                             
Q0164001003PROCHLORPERAZINE MALEATE, 5  MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,   Prochlorperazine maleate 5mg51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0164002004FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q0164003004OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q0165001003PROCHLORPERAZINE MALEATE, 10  MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,  Prochlorperazine maleate10mg51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0165002004FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q0165003004OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q0166001003GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,   Granisetron HCl 1 mg oral   51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0166002004FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q0166003004OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 24 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q0167001003DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A   Dronabinol 2.5mg oral       51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0167002004COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                 
Q0167003004CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q0168001003DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A     Dronabinol 5mg oral         51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0168002004COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                 
Q0168003004CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q0169001003PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRESCRIPTION            Promethazine HCl 12.5mg oral51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0169002004ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q0169003004AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q0170001003PROMETHAZINE HYDROCHLORIDE, 25  MG, ORAL, FDA APPROVED PRESCRIPTION             Promethazine HCl 25 mg oral 51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0170002004ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q0170003004AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q0171001003CHLORPROMAZINE HYDROCHLORIDE, 10  MG, ORAL, FDA APPROVED PRESCRIPTION           Chlorpromazine HCl 10mg oral51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0171002004ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q0171003004AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q0172001003CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION            Chlorpromazine HCl 25mg oral51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0172002004ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q0172003004AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q0173001003TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED PRESCRIPTION        Trimethobenzamide HCl 250mg 51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0173002004ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC                                                                                                                                                                                                                                      
Q0173003004AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                        
Q0174001003THIETHYLPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,   Thiethylperazine maleate10mg51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0174002004FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q0174003004OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q0175001003PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A   Perphenazine 4mg oral       51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0175002004COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                 
Q0175003004CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q0176001003PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A    Perphenazine 8mg oral       51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0176002004COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                 
Q0176003004CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q0177001003HYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR    Hydroxyzine pamoate 25mg    51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0177002004USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                        
Q0177003004CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q0178001003HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR    Hydroxyzine pamoate 50mg    51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0178002004USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                        
Q0178003004CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q0179001003ONDANSETRON HYDROCHLORIDE 8  MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC,   Ondansetron HCl 8mg oral    51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0179002004FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME                                                                                                                                                                                                                                       
Q0179003004OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                    
Q0180001003DOLASETRON MESYLATE, 100  MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR  Dolasetron mesylate oral    51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0180002004USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                        
Q0180003004CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 24 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q0181001003UNSPECIFIED ORAL DOSAGE FORM, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS Unspecified oral anti-emetic51      A                                          4557                                                       D                          O1D 1      01998040119980401        N                           
Q0181002004A COMPLETE THERAPEUTIC SUBSTITUTE FOR A IV ANTI-EMETIC AT THE TIME OF                                                                                                                                                                                                                                                
Q0181003004CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN                                                                                                                                                                                                                                                       
Q0182001003DERMAL AND EPIDERMAL, TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER         Nonmetabolic act d/e tissue 51      A                                                                            J7343                    C                          Z2  S      0200401012005010120041231N                           
Q0182002004BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER                                                                                                                                                                                                                                      
Q0182003004SQUARE CENTIMETER                                                                                                                                                                                                                                                                                                    
Q0183001003DERMAL TISSUE, OF HUMAN ORIGIN, WITH AND WITHOUT OTHER BIOENGINEERED OR         Nonmetabolic active tissue  51      A                                                                            J7344                    C                          O1E S      0199901012005010120041231N                           
Q0183002004PROCESSED ELEMENTS, BUT WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE                                                                                                                                                                                                                                            
Q0183003004CENTIMETER                                                                                                                                                                                                                                                                                                           
Q0184001003DERMAL TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR          Metabolically active tissue 51      A                                                                            J7342                    C                          O1E S      0199901012003010120021231N                           
Q0184002004PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER                                                                                                                                                                                                                                        
Q0187001003FACTOR VIIA (COAGULATION FACTOR, RECOMBINANT) PER 1.2 MG                        Factor viia recombinant     51      A                  2049                                                      J7189                    D                          O1E 1P     0200001012006010120051231D                           
Q0480001003DRIVER FOR USE WITH PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY       Driver pneumatic vad, rep   38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0481001003MICROPROCESSOR CONTROL UNIT FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,    Microprcsr cu elec vad, rep 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0481002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q0482001003MICROPROCESSOR CONTROL UNIT FOR USE WITH ELECTRIC/PNEUMATIC COMBINATION         Microprcsr cu combo vad, rep38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0482002004VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                          
Q0483001003MONITOR/DISPLAY MODULE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,         Monitor elec vad, rep       38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0483002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q0484001003MONITOR/DISPLAY MODULE FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR  Monitor elec or comb vad rep38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0484002004ASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                      
Q0485001003MONITOR CONTROL CABLE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,          Monitor cable elec vad, rep 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0485002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q0486001003MONITOR CONTROL CABLE FOR USE WITH ELECTRIC/PNEUMATIC VENTRICULAR ASSIST        Mon cable elec/pneum vad rep38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0486002004DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q0487001003LEADS (PNEUMATIC/ELECTRICAL) FOR USE WITH ANY TYPE ELECTRIC/PNEUMATIC           Leads any type vad, rep only38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0487002004VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                          
Q0488001003POWER PACK BASE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE, REPLACEMENT    Pwr pack base elec vad, rep 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0488002004ONLY                                                                                                                                                                                                                                                                                                                 
Q0489001003POWER PACK BASE FOR USE WITH ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,      Pwr pck base combo vad, rep 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0489002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q0490001003EMERGENCY POWER SOURCE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,         Emr pwr source elec vad, rep38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0490002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q0491001003EMERGENCY POWER SOURCE FOR USE WITH ELECTRIC/PNEUMATIC VENTRICULAR ASSIST       Emr pwr source combo vad rep38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0491002004DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q0492001003EMERGENCY POWER SUPPLY CABLE FOR USE WITH ELECTRIC VENTRICULAR ASSIST DEVICE,   Emr pwr cbl elec vad, rep   38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0492002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q0493001003EMERGENCY POWER SUPPLY CABLE FOR USE WITH ELECTRIC/PNEUMATIC VENTRICULAR ASSIST Emr pwr cbl combo vad, rep  38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0493002004DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q0494001003EMERGENCY HAND PUMP FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR     Emr hd pmp elec/combo, rep  38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0494002004ASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                      
Q0495001003BATTERY/POWER PACK CHARGER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC          Charger elec/combo vad, rep 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0495002004VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                          
Q0496001003BATTERY FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,  Battery elec/combo vad, rep 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0496002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q0497001003BATTERY CLIPS FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST    Bat clps elec/comb vad, rep 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0497002004DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q0498001003HOLSTER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,  Holster elec/combo vad, rep 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0498002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q0499001003BELT/VEST FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST        Belt/vest elec/combo vad rep38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0499002004DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q0500001003FILTERS FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,  Filters elec/combo vad, rep 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0500002004REPLACEMENT ONLY                                                                                                                                                                                                                                                                                                     
Q0501001003SHOWER COVER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST     Shwr cov elec/combo vad, rep38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0501002004DEVICE, REPLACEMENT ONLY                                                                                                                                                                                                                                                                                             
Q0502001003MOBILITY CART FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY         Mobility cart pneum vad, rep38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0503001003BATTERY FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY, EACH         Battery pneum vad replacemnt38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0504001003POWER ADAPTER FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY,        Pwr adpt pneum vad, rep veh 38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0504002004VEHICLE TYPE                                                                                                                                                                                                                                                                                                         
Q0505001003MISCELLANEOUS SUPPLY OR ACCESSORY FOR USE WITH VENTRICULAR ASSIST DEVICE        Miscl supply/accessory vad  38      A                                                                                                     D                      0121D1F P      02005100120051001        A                           
Q0510001003PHARMACY SUPPLY FEE FOR INITIAL IMMUNOSUPPRESSIVE DRUG(S), FIRST MONTH          Dispens fee immunosupressive46      A                                                                                                     D                      0129O1E 1P     02006010120060101        A                           
Q0510002004FOLLOWING IMPLANT                                                                                                                                                                                                                                                                                                    
Q0511001003PHARMACY SUPPLY FEE FOR ORAL ANTI-CANCER, ORAL ANTI-EMETIC OR IMMUNOSUPPRESSIVE Sup fee antiem,antica,immuno46      A                                                                                                     D                      0129O1E 1P     02006010120060101        A                           
Q0511002004DRUG(S); FOR THE FIRST PRESCRIPTION IN A 30-DAY PERIOD                                                                                                                                                                                                                                                               
Q0512001003PHARMACY SUPPLY FEE FOR ORAL ANTI-CANCER, ORAL ANTI-EMETIC OR IMMUNOSUPPRESSIVE Px sup fee anti-can sub pres46      A                                                                                                     D                      0129D1G 1P     02006010120060101        A                           
Q0512002004DRUG(S); FOR A SUBSEQUENT PRESCRIPTION IN A 30-DAY PERIOD                                                                                                                                                                                                                                                            
Q0513001003PHARMACY DISPENSING FEE FOR INHALATION DRUG(S); PER 30 DAYS                     Disp fee inhal drugs/30 days46      A                                                                                                     D                      0129O1E 1P     02006010120060101        A                           
Q0514001003PHARMACY DISPENSING FEE FOR INHALATION DRUG(S); PER 90 DAYS                     Disp fee inhal drugs/90 days46      A                                                                                                     D                      0129O1E 1P     02006010120060101        A                           
Q0515001003INJECTION, SERMORELIN ACETATE, 1 MICROGRAM                                      Sermorelin acetate injection51      A                  2049                                                                               D                          O1E 1P     02006010120060101        A                           
Q1001001003NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 1 AS DEFINED IN FEDERAL REGISTER       Ntiol category 1            57      A                                                                                                     D                      0086D1F F      0199907012005070120050630D                           
Q1001002004NOTICE, VOL 65, DATED MAY 3, 2000                                                                                                                                                                                                                                                                                    
Q1002001003NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 2 AS DEFINED IN FEDERAL REGISTER       Ntiol category 2            57      A                                                                                                     D                      0086D1F F      0199907012005070120050630D                           
Q1002002004NOTICE, VOL 65, DATED MAY 3, 2000                                                                                                                                                                                                                                                                                    
Q1003001003NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 3 AS DEFINED IN FEDERAL REGISTER NOTICENtiol category 3            57      A                                                                                                     D                      0086D1F F      01999070120031001        N                           
Q1004001003NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 4 AS DEFINED IN FEDERAL REGISTER NOTICENtiol category 4            57      A                                                                                                     D                      0086D1F F      01999070120031001        N                           
Q1005001003NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 5 AS DEFINED IN FEDERAL REGISTER NOTICENtiol category 5            57      A                                                                                                     D                      0086D1F F      01999070120031001        N                           
Q2001001003ORAL, CABERGOLINE, 0.5 MG                                                       Oral cabergoline 0.5 mg     00      9                  2049.5                                                                             M                          O1E 1P     0200007012006010120051231D                           
Q2002001003INJECTION, ELLIOTTS B SOLUTION, PER ML                                          Elliotts b solution per ml  51      A                  2049                    1861S2B                           J9175                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2003001003INJECTION, APROTININ, 10,000 KIU                                                Aprotinin, 10,000 kiu       51      A                  2049                    1861S2B                           J0365                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2004001003IRRIGATION SOLUTION FOR TREATMENT OF BLADDER CALCULI, FOR EXAMPLE RENACIDIN,    Bladder calculi irrig sol   51      A                  2049                    1861S2B                                                    D                      0095O1E 1P     02000070120000701        N                           
Q2004002004PER 500 ML                                                                                                                                                                                                                                                                                                           
Q2005001003INJECTION, CORTICORELIN OVINE TRIFLUTATE, PER DOSE                              Corticorelin ovine triflutat51      A                  2049                    1861S2B                                                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2006001003INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL                                 Digoxin immune fab (ovine)  51      A                  2049                    1861S2B                           J1162                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2007001003INJECTION, ETHANOLAMINE OLEATE, 100 MG                                          Ethanolamine oleate 100 mg  51      A                  2049                    1861S2B                           J1430                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2008001003INJECTION, FOMEPIZOLE, 15 MG                                                    Fomepizole, 15 mg           51      A                  2049                    1861S2B                           J1451                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2009001003INJECTION, FOSPHENYTOIN, 50 MG                                                  Fosphenytoin, 50 mg         51      A                  2049                    1861S2B                                                    D                      0095O1E 1P     02000070120000701        N                           
Q2010001003INJECTION, GLATIRAMER ACETATE, PER DOSE                                         Glatiramer acetate, per dose51      A                  2049                    1861S2B                                                    D                      0095O1E 1P     0200007012004010120031231N                           
Q2011001003INJECTION, HEMIN, PER 1 MG                                                      Hemin, per 1 mg             51      A                  2049                    1861S2B                           J1640                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2012001003INJECTION, PEGADEMASE BOVINE, 25 IU                                             Pegademase bovine, 25 iu    51      A                  2049                    1861S2B                           J2504                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2013001003INJECTION, PENTASTARCH, 10% SOLUTION, PER 100 ML                                Pentastarch 10% solution    51      A                  2049                    1861S2B                           J2513                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2014001003INJECTION, SERMORELIN ACETATE, 0.5 MG                                           Sermorelin acetate, 0.5 mg  51      A                  2049                    1861S2B                                                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2017001003INJECTION, TENIPOSIDE, 50 MG                                                    Teniposide, 50 mg           51      A                  2049                    1861S2B                                                    D                      0095O1D 1P     02000070120000701        N                           
Q2018001003INJECTION, UROFOLLITROPIN, 75 IU                                                Urofollitropin, 75 iu       51      A                  2049                    1861S2B                           J3355                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2019001003INJECTION, BASILIXIMAB, 20 MG                                                   Basiliximab                 51      A                  2049                                                      J0480                    D                      0095O1E 1G     0200007012006010120051231D                           
Q2020001003INJECTION, HISTRELIN ACETATE, 10 MCG                                            Histrelin acetate           51      A                  2049                    1861S2B                           J1675                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2021001003INJECTION, LEPIRUDIN, 50 MG                                                     Lepirudin                   51      A                  2049                    1861S2B                           J1945                    D                      0095O1E 1P     0200007012006010120051231D                           
Q2022001003VON WILLEBRAND FACTOR COMPLEX, HUMAN, PER IU                                    VonWillebrandFactrCmplxperIU51      A35.30             2049.5                                                    J7188                    D                      0095O1E 1P     0200007012006010120051231D                           
Q3000001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, RUBIDIUM RB-82, PER DOSERubidium RB-82              99      9                                                                                                     D                      0093I1E 4      0200301012006010120051231D                           
Q3001001003RADIOELEMENTS FOR BRACHYTHERAPY, ANY TYPE, EACH                                 Brachytherapy Radioelements 57      A                  15022                                                                              D                          P7A 1      02000070120050101        F                           
Q3002001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, GALLIUM GA 67, PER MCI  Gallium ga 67               57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3003001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M        Technetium tc99m bicisate   57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3003002004BICISATE, PER UNIT DOSE                                                                                                                                                                                                                                                                                              
Q3004001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, XENON XE 133, PER 10 MCIXenon xe 133                57      A                  15022                                                                              D                          I1E 4      0200007012006010120051231D                           
Q3005001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M       Technetium tc99m mertiatide 57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3005002004MERTIATIDE, PER MCI                                                                                                                                                                                                                                                                                                  
Q3006001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M       Technetium tc99m glucepatate57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3006002004GLUCEPATATE, PER 5 MCI                                                                                                                                                                                                                                                                                               
Q3007001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM PHOSPHATE P32,   Sodium phosphate p32        57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3007002004PER MCI                                                                                                                                                                                                                                                                                                              
Q3008001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111-IN           Indium 111-in pentetreotide 57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3008002004PENTETREOTIDE, PER 3 MCI                                                                                                                                                                                                                                                                                             
Q3009001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M        Technetium tc99m oxidronate 57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3009002004OXIDRONATE, PER MCI                                                                                                                                                                                                                                                                                                  
Q3010001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M -      Technetium tc99mlabeledrbcs 57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3010002004LABELED RED BLOOD CELLS, PER MCI                                                                                                                                                                                                                                                                                     
Q3011001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CHROMIC PHOSPHATE P32   Chromic phosphate p32       57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3011002004SUSPENSION, PER MCI                                                                                                                                                                                                                                                                                                  
Q3012001003SUPPLY OF ORAL RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CYANOCOBALAMIN     Cyanocobalamin cobalt co57  57      A                  15022                                                                              D                      0095I1E 4      0200007012006010120051231D                           
Q3012002004COBALT CO57, PER 0.5 MCI                                                                                                                                                                                                                                                                                             
Q3014001003TELEHEALTH ORIGINATING SITE FACILITY FEE                                        Telehealth facility fee     53      A                                                                                                     C                          Y2  9      02001100120011001        N                           
Q3017001003AMBULANCE SERVICE, ADVANCED LIFE SUPPORT (ALS) ASSESSMENT, NO OTHER ALS         ALS assessment              52      A                                                                                                     C                          O1A D      0200201012003010120021231N                           
Q3017002004SERVICES PROVIDED                                                                                                                                                                                                                                                                                                    
Q3019001003ALS VEHICLE USED, EMERGENCY TRANSPORT, NO ALS LEVEL SERVICES FURNISHED          ALS emer trans no ALS serv  52      A                                                                                                     C                          O1A D      02002040120020401        N                           
Q3020001003ALS VEHICLE USED, NON-EMERGENCY TRANSPORT, NO ALS LEVEL SERVICE FURNISHED       ALS nonemer trans no ALS ser52      A                                                                                                     C                          O1A D      02002040120020401        N                           
Q3025001003INJECTION, INTERFERON BETA-1A, 11 MCG FOR INTRAMUSCULAR USE                     IM inj interferon beta 1-a  51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
Q3026001003INJECTION, INTERFERON BETA-1A, 11 MCG FOR SUBCUTANEOUS USE                      Subc inj interferon beta-1a 00      9                                                                                                     I                          O1E 1P     02003010120030101        N                           
Q3030001003SODIUM HYALURONATE PER 20 TO 25 MG DOSE, FOR INTRA-ARTICULAR INJECTION          Sodium hyaluronate 20-25 mg 51      A                                                                            J7317                    C                          O1E 1P     0200207012003010120021231N                           
Q3031001003COLLAGEN SKIN TEST                                                              Collagen skin test          11      A65-9                                                                                                 D                          D1A 5      02003040120041001        N                           
Q4001001003CASTING SUPPLIES, BODY CAST ADULT, WITH OR WITHOUT HEAD, PLASTER                Cast sup body cast plaster  52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4002001003CAST SUPPLIES, BODY CAST ADULT, WITH OR WITHOUT HEAD, FIBERGLASS                Cast sup body cast fiberglas52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4003001003CAST SUPPLIES, SHOULDER CAST, ADULT (11 YEARS +), PLASTER                       Cast sup shoulder cast plstr52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4004001003CAST SUPPLIES, SHOULDER CAST, ADULT (11 YEARS +), FIBERGLASS                    Cast sup shoulder cast fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4005001003CAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), PLASTER                       Cast sup long arm adult plst52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4006001003CAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), FIBERGLASS                    Cast sup long arm adult fbrg52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4007001003CAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER                   Cast sup long arm ped plster52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4008001003CAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS                Cast sup long arm ped fbrgls52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4009001003CAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), PLASTER                      Cast sup sht arm adult plstr52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4010001003CAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), FIBERGLASS                   Cast sup sht arm adult fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4011001003CAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER                  Cast sup sht arm ped plaster52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4012001003CAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS               Cast sup sht arm ped fbrglas52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4013001003CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS Cast sup gauntlet plaster   52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4013002004+), PLASTER                                                                                                                                                                                                                                                                                                          
Q4014001003CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS Cast sup gauntlet fiberglass52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4014002004+), FIBERGLASS                                                                                                                                                                                                                                                                                                       
Q4015001003CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), PEDIATRIC (0-10 Cast sup gauntlet ped plster52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4015002004YEARS), PLASTER                                                                                                                                                                                                                                                                                                      
Q4016001003CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), PEDIATRIC (0-10 Cast sup gauntlet ped fbrgls52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4016002004YEARS), FIBERGLASS                                                                                                                                                                                                                                                                                                   
Q4017001003CAST SUPPLIES, LONG ARM SPLINT, ADULT (11 YEARS +), PLASTER                     Cast sup lng arm splint plst52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4018001003CAST SUPPLIES, LONG ARM SPLINT, ADULT (11 YEARS +), FIBERGLASS                  Cast sup lng arm splint fbrg52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4019001003CAST SUPPLIES, LONG ARM SPLINT, PEDIATRIC (0-10 YEARS), PLASTER                 Cast sup lng arm splnt ped p52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4020001003CAST SUPPLIES, LONG ARM SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS              Cast sup lng arm splnt ped f52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4021001003CAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YEARS +), PLASTER                    Cast sup sht arm splint plst52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4022001003CAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YEARS +), FIBERGLASS                 Cast sup sht arm splint fbrg52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4023001003CAST SUPPLIES, SHORT ARM SPLINT, PEDIATRIC (0-10 YEARS), PLASTER                Cast sup sht arm splnt ped p52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4024001003CAST SUPPLIES, SHORT ARM SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS             Cast sup sht arm splnt ped f52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4025001003CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), ADULT (11 YEARS +), PLASTER        Cast sup hip spica plaster  52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4026001003CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), ADULT (11 YEARS +), FIBERGLASS     Cast sup hip spica fiberglas52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4027001003CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), PEDIATRIC (0-10 YEARS), PLASTER    Cast sup hip spica ped plstr52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4028001003CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), PEDIATRIC (0-10 YEARS), FIBERGLASS Cast sup hip spica ped fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4029001003CAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), PLASTER                       Cast sup long leg plaster   52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4030001003CAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), FIBERGLASS                    Cast sup long leg fiberglass52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4031001003CAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER                   Cast sup lng leg ped plaster52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4032001003CAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS                Cast sup lng leg ped fbrgls 52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4033001003CAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), PLASTER              Cast sup lng leg cylinder pl52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4034001003CAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), FIBERGLASS           Cast sup lng leg cylinder fb52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4035001003CAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), PLASTER          Cast sup lngleg cylndr ped p52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4036001003CAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS       Cast sup lngleg cylndr ped f52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4037001003CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), PLASTER                      Cast sup shrt leg plaster   52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4038001003CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), FIBERGLASS                   Cast sup shrt leg fiberglass52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4039001003CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER                  Cast sup shrt leg ped plster52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4040001003CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS               Cast sup shrt leg ped fbrgls52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4041001003CAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), PLASTER                     Cast sup lng leg splnt plstr52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4042001003CAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS                  Cast sup lng leg splnt fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4043001003CAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER                 Cast sup lng leg splnt ped p52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4044001003CAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS              Cast sup lng leg splnt ped f52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4045001003CAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), PLASTER                    Cast sup sht leg splnt plstr52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4046001003CAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS                 Cast sup sht leg splnt fbrgl52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4047001003CAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER                Cast sup sht leg splnt ped p52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4048001003CAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS             Cast sup sht leg splnt ped f52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4049001003FINGER SPLINT, STATIC                                                           Finger splint, static       52      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4050001003CAST SUPPLIES, FOR UNLISTED TYPES AND MATERIALS OF CASTS                        Cast supplies unlisted      57      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4051001003SPLINT SUPPLIES, MISCELLANEOUS (INCLUDES THERMOPLASTICS, STRAPPING, FASTENERS,  Splint supplies misc        57      A                                                                                                     C                          D1A S      02001070120010701        N                           
Q4051002004PADDING AND OTHER SUPPLIES)                                                                                                                                                                                                                                                                                          
Q4052001003INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG             Octreotide injection, depot 51      A                                                                            J2353                    C                          O1E 1P     0200307012004010120031231N                           
Q4053001003INJECTION, PEGFILGRASTIM, 1 MG                                                  Pegfilgrastim, 1 mg         51      A                  2049                                                      J2505                    D                          O1E 1P     0200307012004010120031231N                           
Q4054001003INJECTION, DARBEPOETIN ALFA, 1 MCG (FOR ESRD ON DIALYSIS)                       Darbepoetin alfa, esrd use  57      A                  4273.1                                                    J0882                    D                          O1E 1L     0200401012006010120051231D                           
Q4055001003INJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS)                      Epoetin alfa, esrd use      57      A                  4273.1                                                    J0886                    D                          O1E 1L     0200401012006010120051231D                           
Q4075001003INJECTION, ACYCLOVIR, 5 MG                                                      Acyclovir, 5 mg             51      A                                                                            J0133                    C                          O1E 1P     0200310012006010120051231D                           
Q4076001003INJECTION, DOPAMINE HCL, 40 MG                                                  Dopamine hcl, 40 mg         51      A                                                                            J1265                    C                          O1E 1P     0200310012006010120051231D                           
Q4077001003INJECTION, TREPROSTINIL, 1 MG                                                   Treprostinil, 1 mg          51      A                                                                            J3285                    C                          O1E 1P     0200310012006010120051231D                           
Q4078001003SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, AMMONIA N-13, PER DOSE  Ammonia N-13, per dose      53      A                  4273.1                                                    A9526                    D                          I1E 4      0200310012004010120031231N                           
Q4079001003INJECTION, NATALIZUMAB, 1 MG                                                    Natalizumab injection       51      A                                                                                                     C                          O1E 1P     02005010120050101        A                           
Q4080001003ILOPROST, INHALATION SOLUTION, ADMINISTERED THROUGH DME, 20 MICROGRAMS          Iloprost inhalation solution51      A                                                                                                     C                          D1G 1P     02005070120050701        A                           
Q9920001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 20 OR LESS                  Epoetin with hct <= 20      57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9921001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 21                          Epoetin with hct = 21       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9922001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 22                          Epoetin with hct = 22       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9923001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 23                          Epoetin with hct = 23       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9924001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 24                          Epoetin with hct = 24       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9925001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 25                          Epoetin with hct = 25       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9926001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 26                          Epoetin with hct = 26       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9927001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 27                          Epoetin with hct = 27       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9928001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 28                          Epoetin with hct = 28       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9929001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 29                          Epoetin with hct = 29       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9930001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 30                          Epoetin with hct = 30       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9931001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 31                          Epoetin with hct = 31       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9932001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 32                          Epoetin with hct = 32       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9933001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 33                          Epoetin with hct = 33       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9934001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 34                          Epoetin with hct = 34       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9935001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 35                          Epoetin with hct = 35       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9936001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 36                          Epoetin with hct = 36       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9937001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 37                          Epoetin with hct = 37       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9938001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 38                          Epoetin with hct = 38       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9939001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 39                          Epoetin with hct = 39       57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9940001003INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 40 OR ABOVE                 Epoetin with hct >= 40      57      A                  4273.1                                                                             D                          O1E 1L     0199101012004010120031231N                           
Q9941001003INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED, 1G                        IVIG lyophil 1G             51      A                  2049                                                                               D                          O1E 1P     0200504012006010120051231D                           
Q9942001003INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED, 10 MG                     IVIG lyophil 10 mg          51      A                  2049                                                                               D                          O1E 1P     0200504012006010120051231D                           
Q9943001003INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED, 1G                    IVIG non-lyophil 1G         51      A                  2049                                                                               D                          O1E 1P     0200504012006010120051231D                           
Q9944001003INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED, 10 MG                 IVIG non-lyophil 10 mg      51      A                  2049                                                                               D                          O1E 1P     0200504012006010120051231D                           
Q9945001003LOW OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION, PER ML     LOCM <=149 mg/ml iodine, 1ml51      A                  15022                                                                              D                          I1E 4      02005040120050401        A                           
Q9946001003LOW OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML       LOCM 150-199mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005040120050401        A                           
Q9947001003LOW OSMOLAR CONTRAST MATERIAL, 200-249 MG/ML IODINE CONCENTRATION, PER ML       LOCM 200-249mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005040120050401        A                           
Q9948001003LOW OSMOLAR CONTRAST MATERIAL, 250-299 MG/ML IODINE CONCENTRATION, PER ML       LOCM 250-299mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005040120050401        A                           
Q9949001003LOW OSMOLAR CONTRAST MATERIAL, 300-349 MG/ML IODINE CONCENTRATION, PER ML       LOCM 300-349mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005040120050401        A                           
Q9950001003LOW OSMOLAR CONTRAST MATERIAL, 350-399 MG/ML IODINE CONCENTRATION, PER ML       LOCM 350-399mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005040120050401        A                           
Q9951001003LOW OSMOLAR CONTRAST MATERIAL, 400 OR GREATER MG/ML IODINE CONCENTRATION, PER MLLOCM >= 400 mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005040120050401        A                           
Q9952001003INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, PER ML           Inj Gad-base MR contrast,1ml57      A                  15022                                                                              D                          I1F 4      02005040120050401        A                           
Q9953001003INJECTION, IRON-BASED MAGNETIC RESONANCE CONTRAST AGENT, PER ML                 Inj Fe-based MR contrast,1ml57      A                  15022                                                                              D                          I1F 4      02005040120050401        A                           
Q9954001003ORAL MAGNETIC RESONANCE CONTRAST AGENT, PER 100 ML                              Oral MR contrast, 100 ml    57      A                  15022                                                                              D                          I1F 4      02005040120050401        A                           
Q9955001003INJECTION, PERFLEXANE LIPID MICROSPHERES, PER ML                                Inj perflexane lip micros,ml57      A                                                                                                     C                          I1F 4      02005040120050401        A                           
Q9956001003INJECTION, OCTAFLUOROPROPANE MICROSPHERES, PER ML                               Inj octafluoropropane mic,ml57      A                                                                                                     C                          I1F 4      02005040120050401        A                           
Q9957001003INJECTION, PERFLUTREN LIPID MICROSPHERES, PER ML                                Inj perflutren lip micros,ml57      A                                                                                                     C                          I1F 4      02005040120050401        A                           
Q9958001003HIGH OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION, PER ML    HOCM <=149 mg/ml iodine, 1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        A                           
Q9959001003HIGH OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML      HOCM 150-199mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        A                           
Q9960001003HIGH OSMOLAR CONTRAST MATERIAL, 200-249 MG/ML IODINE CONCENTRATION, PER ML      HOCM 200-249mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        A                           
Q9961001003HIGH OSMOLAR CONTRAST MATERIAL, 250-299 MG/ML IODINE CONCENTRATION, PER ML      HOCM 250-299mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        A                           
Q9962001003HIGH OSMOLAR CONTRAST MATERIAL, 300-349 MG/ML IODINE CONCENTRATION, PER ML      HOCM 300-349mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        A                           
Q9963001003HIGH OSMOLAR CONTRAST MATERIAL, 350-399 MG/ML IODINE CONCENTRATION, PER ML      HOCM 350-399mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        A                           
Q9964001003HIGH OSMOLAR CONTRAST MATERIAL, 400 OR GREATER MG/ML IODINE CONCENTRATION, PER  HOCM>= 400mg/ml iodine, 1ml 51      A                  15022                                                                              D                          I1E 4      02005070120050701        A                           
Q9964002004ML                                                                                                                                                                                                                                                                                                                   
R0070001003TRANSPORTATION OF PORTABLE X-RAY EQUIPMENT AND PERSONNEL TO HOME OR NURSING     Transport portable x-ray    13      A                  2070.4  5244.B                                                                     D                          I1F 4      01982010119980101        N                           
R0070002004HOME, PER TRIP TO FACILITY OR LOCATION, ONE PATIENT SEEN                                                                                                                                                                                                                                                             
R0075001003TRANSPORTATION OF PORTABLE X-RAY EQUIPMENT AND PERSONNEL TO HOME OR NURSING     Transport port x-ray multipl13      A                  2070.4  5244.B                                                                     D                          I1F 4      01986010119980101        N                           
R0075002004HOME, PER TRIP TO FACILITY OR LOCATION, MORE THAN ONE PATIENT SEEN                                                                                                                                                                                                                                                   
R0076001003TRANSPORTATION OF PORTABLE EKG TO FACILITY OR LOCATION, PER PATIENT             Transport portable EKG      13      A50-15             2070.1  2070.4                                                                     D                      0061T2C 5      01984010119980101        N                           
S0009001003INJECTION, BUTORPHANOL TARTRATE, 1 MG                                           Injection, butorphanol tartr00      9                                                                                                     I                      0088Z2  1P     0200001012004010120031231N                           
S0012001003BUTORPHANOL TARTRATE, NASAL SPRAY, 25 MG                                        Butorphanol tartrate, nasal 00      9                                                                                                     I                      0088Z2  1      02000010120000101        N                           
S0014001003TACRINE HYDROCHLORIDE, 10 MG                                                    Tacrine hydrochloride, 10 mg00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0016001003INJECTION, AMIKACIN SULFATE, 500 MG                                             Injection, amikacin sulfate 00      9                                                                            S0072                    I                      0088Z2  1P     0200001012005040120050331D                           
S0017001003INJECTION, AMINOCAPROIC ACID, 5 GRAMS                                           Injection, aminocaproic acid00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0020001003INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML                                     Injection, bupivicaine hydro00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0021001003INJECTION, CEFOPERAZONE SODIUM, 1 GRAM                                          Injection, cefoperazone sod 00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0023001003INJECTION, CIMETIDINE HYDROCHLORIDE, 300 MG                                     Injection, cimetidine hydroc00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0028001003INJECTION, FAMOTIDINE, 20 MG                                                    Injection, famotidine, 20 mg00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0030001003INJECTION, METRONIDAZOLE, 500 MG                                                Injection, metronidazole    00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0032001003INJECTION, NAFCILLIN SODIUM, 2 GRAMS                                            Injection, nafcillin sodium 00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0034001003INJECTION, OFLOXACIN, 400 MG                                                    Injection, ofloxacin, 400 mg00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0039001003INJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML                             Injection, sulfamethoxazole 00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0040001003INJECTION, TICARCILLIN DISODIUM AND CLAVULANATE POTASSIUM, 3.1 GRAMS            Injection, ticarcillin disod00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0071001003INJECTION, ACYCLOVIR SODIUM, 50 MG                                              Injection, acyclovir sodium 00      9                                                                                                     I                      0088Z2  1P     0200001012006010120051231D                           
S0072001003INJECTION, AMIKACIN SULFATE, 100 MG                                             Injection, amikacin sulfate 00      9                                                                                                     I                      0088Z2  1P     0200001012006010120051231D                           
S0073001003INJECTION, AZTREONAM, 500 MG                                                    Injection, aztreonam, 500 mg00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0074001003INJECTION, CEFOTETAN DISODIUM, 500 MG                                           Injection, cefotetan disodiu00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0077001003INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG                                        Injection, clindamycin phosp00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0078001003INJECTION, FOSPHENYTOIN SODIUM, 750 MG                                          Injection, fosphenytoin sodi00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0079001003INJECTION, OCTREOTIDE ACETATE, 100 MCG (FOR DOSES OVER 1 MG USE J2352 OR C1207) Octreotide 100 mcg          00      9                                                                                                     I                      0088Z2  1P     0200201012004010120031231N                           
S0080001003INJECTION, PENTAMIDINE ISETHIONATE, 300 MG                                      Injection, pentamidine iseth00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0081001003INJECTION, PIPERACILLIN SODIUM, 500 MG                                          Injection, piperacillin sodi00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0085001003INJECTION, GATIFLOXACIN, 200 MG                                                 injection, gatifloxacin     00      9                                                                            J1590                    I                      0088Z2  1P     0200101012003010120021231N                           
S0087001003ALEMTUZUMAB INJECTION, 30 MG                                                    Alemtuzumab 30 mg           00      9                                                                            J9010                    I                      0088Z2  1P     0200201012003010120021231N                           
S0088001003IMATINIB INJECTION, 100 MG                                                      Imatinib 100 mg             00      9                                                                                                     I                      0088Z2  9      02002010120030101        N                           
S0090001003SILDENAFIL CITRATE, 25 MG                                                       Sildenafil citrate, 25 mg   00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0091001003GRANISETRON HYDROCHLORIDE, 1MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE    Granisetron 1mg             00      9                                                                                                     I                      0088Z2  9      02002010120010701        N                           
S0091002004STATUTE, USE Q0166)                                                                                                                                                                                                                                                                                                  
S0092001003INJECTION, HYDROMORPHONE HYDROCHLORIDE, 250 MG (LOADING DOSE FOR INFUSION PUMP) Hydromorphone 250 mg        00      9                                                                                                     I                      0088Z2  9      02002010120010701        N                           
S0093001003INJECTION, MORPHINE SULFATE, 500 MG (LOADING DOSE FOR INFUSION PUMP)            Morphine 500 mg             00      9                                                                                                     I                      0088Z2  9      02002010120010701        N                           
S0104001003ZIDOVUDINE, ORAL, 100 MG                                                        Zidovudine, oral, 100 mg    00      9                                                                                                     I                          Z2  1      02002100120021001        N                           
S0106001003BUPROPION HCL SUSTAINED RELEASE TABLET, 150 MG, PER BOTTLE OF 60 TABLETS        Bupropion HCL SR 60 tablets 00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S0107001003INJECTION, OMALIZUMAB, 25 MG                                                    Inj, omalizumab 25 mg       00      9                                                                            J2357                    I                          Z2  9      0200401012005040120050331D                           
S0108001003MERCAPTOPURINE, ORAL, 50 MG                                                     Mercaptopurine 50 mg        00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S0109001003METHADONE, ORAL, 5 MG                                                           Methadone oral 5mg          00      9                                                                                                     I                          Z2  9      02004100120041001        N                           
S0112001003INJECTION, DARBEPOETIN ALFA, 1 MCG                                              Inj darbepoetin             00      9                                                                            J0880                    I                          Z2  1      0200207012003010120021231N                           
S0114001003INJECTION, TREPROSTINIL SODIUM, 0.5 MG                                          Inj treprostinil 0.5 mg     00      9                                                                                                     I                          Z2  9      0200301012006010120051231D                           
S0115001003BORTEZOMIB, 3.5 MG                                                              Bortezomib 3.5 mg           00      9                                                                                                     I                          Z2  9      0200401012005010120041231N                           
S0116001003BEVACIZUMAB, 100 MG                                                             Bevacizumab 100 mg          00      9                                                                                                     I                          Z2  9      02004070120040701        N                           
S0117001003TRETINOIN, TOPICAL, 5 GRAMS                                                     Tretinoin topical 5 g       00      9                                                                                                     I                          Z2  9      02004070120040701        N                           
S0118001003INJECTION, ZICONOTIDE, FOR INTRATHECAL INFUSION, 1 MCG                          Ziconotide inthrathecal 1mcg00      9                                                                                                     I                          Z2  9      0200507012006010120051231D                           
S0122001003INJECTION, MENOTROPINS, 75 IU                                                   Inj menotropins 75 iu       00      9                                                                                                     I                          Z2  1P     02002040120020401        N                           
S0124001003INJECTION, UROFOLLITROPIN, PURIFIED, 75 IU                                      Inj urofollitropin 75 iu    00      9                                                                                                     I                          Z2  1P     0200204012004010120031231N                           
S0126001003INJECTION, FOLLITROPIN ALFA, 75 IU                                              Inj follitropin alfa 75 iu  00      9                                                                                                     I                          Z2  1P     02002040120020401        N                           
S0128001003INJECTION, FOLLITROPIN BETA, 75 IU                                              Inj follitropin beta 75 iu  00      9                                                                                                     I                          Z2  1P     02002040120020401        N                           
S0130001003INJECTION, CHORIONIC GONADOTROPIN, 5000 UNITS                                   Inj c gonadotropin 5000 iu  00      9                                                                                                     I                          Z2  1P     0200204012004010120031231N                           
S0132001003INJECTION, GANIRELIX ACETATE, 250 MCG                                           Inj ganirelix acetat 250 mcg00      9                                                                                                     I                          Z2  1P     02002040120020401        N                           
S0133001003HISTRELIN, IMPLANT, 50 MG                                                       Histrelin implant           00      9                                                                                                     I                          Z2  9      02005070120050701        A                           
S0135001003INJECTION, PEGFILGRASTIM, 6 MG                                                  Pegfilgrastim injection 6mg 00      9                                                                                                     I                          Z2  1P     0200210012004010120031231N                           
S0136001003CLOZAPINE, 25 MG                                                                Clozapine, 25 mg            00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S0137001003DIDANOSINE (DDI), 25 MG                                                         Didanosine, 25 mg           00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S0138001003FINASTERIDE, 5 MG                                                               Finasteride, 5 mg           00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S0139001003MINOXIDIL, 10 MG                                                                Minoxidil, 10 mg            00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S0140001003SAQUINAVIR, 200 MG                                                              Saquinavir, 200 mg          00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S0141001003ZALCITABINE (DDC), 0.375 MG                                                     Zalcitabine, 0.375 mg       00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S0142001003COLISTIMETHATE SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DME,            Colistimethate inh sol mg   00      9                                                                                                     I                          Z2  9      02005040120050401        A                           
S0142002004CONCENTRATED FORM, PER MG                                                                                                                                                                                                                                                                                            
S0143001003AZTREONAM, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER Aztreonam, inh sol gram     00      9                                                                                                     I                          Z2  9      02005040120050401        A                           
S0143002004GRAM                                                                                                                                                                                                                                                                                                                 
S0145001003INJECTION, PEGYLATED INTERFERON ALFA-2A, 180 MCG PER ML                         Peg interferon alfa-2A/180  00      9                                                                                                     I                          Z2  9      02005070120050701        A                           
S0146001003INJECTION, PEGYLATED INTERFERON ALFA-2B, 10 MCG PER 0.5 ML                      Peg interferon alfa-2b/10   00      9                                                                                                     I                          Z2  9      02005070120050701        A                           
S0155001003STERILE DILUTANT FOR EPOPROSTENOL, 50ML                                         Epoprostenol dilutant       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0156001003EXEMESTANE, 25 MG                                                               Exemestane, 25 mg           00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S0157001003BECAPLERMIN GEL 0.01%, 0.5 GM                                                   Becaplermin gel 1%, 0.5 gm  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S0158001003INJECTION, LARONIDASE, 0.58 MG                                                  Injection laronidase        00      9                                                                            J1931                    I                          Z2  9      0200404012005040120050331D                           
S0159001003INJECTION, AGALSIDASE BETA, 35 MG                                               Injection agalsidase        00      9                                                                            J0180                    I                          Z2  9      0200404012005040120050331D                           
S0160001003DEXTROAMPHETAMINE SULFATE, 5 MG                                                 Dextroamphetamine           00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S0161001003CALCITROL, 0.25 MG                                                              Calcitrol                   00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S0162001003INJECTION, EFALIZUMAB, 125 MG                                                   Injection efalizumab        00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S0163001003INJECTION, RISPERIDONE, LONG ACTING, 12.5 MG                                    Injection risperidoneLA     00      9                                                                                                     I                          Z2  9      0200404012005010120041231N                           
S0164001003INJECTION, PANTOPRAZOLE SODIUM, 40 MG                                           Injection pantroprazole     00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S0165001003INJECTION, ABARELIX, 100 MG                                                     Injection abarelix          00      9                                                                                                     I                          Z2  9      0200404012005010120041231N                           
S0166001003INJECTION, OLANZAPINE, 2.5 MG                                                   Inj olanzapine 2.5mg        00      9                                                                                                     I                          Z2  9      02004100120041001        N                           
S0167001003INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG                                      Inj apomorphine HCl 1mg     00      9                                                                                                     I                          Z2  9      02004100120041001        N                           
S0168001003INJECTION, AZACITIDINE, 100 MG                                                  Inj azacitidine 100mg       00      9                                                                                                     I                          Z2  9      0200410012006010120051231D                           
S0170001003ANASTROZOLE, ORAL, 1MG                                                          Anastrozole 1 mg            00      9                                                                                                     I                      0088Z2  1P     02002010120020101        N                           
S0171001003INJECTION, BUMETANIDE, 0.5MG                                                    Bumetanide 0.5 mg           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0172001003CHLORAMBUCIL, ORAL, 2MG                                                         Chlorambucil 2 mg           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0173001003DEXAMETHASONE, ORAL, 4MG                                                        Dexamethasone 4 mg          00      9                                                                                                     I                      0088Z2  9      0200201012006010120051231D                           
S0174001003DOLASETRON MESYLATE, ORAL 50MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE    Dolasetron 50 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0174002004STATUTE, USE Q0180)                                                                                                                                                                                                                                                                                                  
S0175001003FLUTAMIDE, ORAL, 125MG                                                          Flutamide 125 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0176001003HYDROXYUREA, ORAL, 500MG                                                        Hydroxyurea 500 mg          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0177001003LEVAMISOLE HYDROCHLORIDE, ORAL, 50MG                                            Levamisole 50 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0178001003LOMUSTINE, ORAL, 10MG                                                           Lomustine 10 mg             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0179001003MEGESTROL ACETATE, ORAL, 20MG                                                   Megestrol 20 mg             00      9                                                                                                     I                      0088Z2  1P     02002010120020101        N                           
S0181001003ONDANSETRON HYDROCHLORIDE, ORAL, 4MG (FOR CIRCUMSTANCES FALLING UNDER THE       Ondansetron 4 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0181002004MEDICARE STATUTE, USE Q0179)                                                                                                                                                                                                                                                                                         
S0182001003PROCARBAZINE HYDROCHLORIDE, ORAL, 50MG                                          Procarbazine 5 mg           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0183001003PROCHLORPERAZINE MALEATE, ORAL, 5MG (FOR CIRCUMSTANCES FALLING UNDER THE        Prochlorperazine 5 mg       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0183002004MEDICARE STATUTE, USE Q0164 - Q0165)                                                                                                                                                                                                                                                                                 
S0187001003TAMOXIFEN CITRATE, ORAL, 10MG                                                   Tamoxifen 10 mg             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0189001003TESTOSTERONE PELLET, 75MG                                                       Testosterone pellet 75 mg   00      9                                                                                                     I                      0088Z2  1P     02002010120020101        N                           
S0190001003MIFEPRISTONE, ORAL, 200 MG                                                      Mifepristone, oral, 200 mg  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S0191001003MISOPROSTOL, ORAL, 200 MCG                                                      Misoprostol, oral, 200 mcg  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S0193001003INJECTION, ALEFACEPT, 7.5 MG (INCLUDES DOSE PACKAGING)                          Inj alefacept 7.5 mg        00      9                                                                                                     I                          Z2  9      0200310012004010120031231N                           
S0194001003DIALYSIS/STRESS VITAMIN SUPPLEMENT, ORAL, 100 CAPSULES                          Vitamin suppl 100 caps      00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S0195001003PNEUMOCOCCAL CONJUGATE VACCINE, POLYVALENT, INTRAMUSCULAR, FOR CHILDREN FROM    Pneumo vaccine 5-9 yrs      00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S0195002004FIVE YEARS TO NINE YEARS OF AGE WHO HAVE NOT PREVIOUSLY RECEIVED THE VACCINE                                                                                                                                                                                                                                         
S0196001003INJECTABLE POLY-L-LACTIC ACID, RESTORATIVE IMPLANT, 1 ML, FACE (DEEP DERMIS,    Poly-l-lactic acid 1ml face 00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
S0196002004SUBCUTANEOUS LAYERS)                                                                                                                                                                                                                                                                                                 
S0197001003PRENATAL VITAMINS, 30-DAY SUPPLY                                                Prenatal vitamins 30 day    00      9                                                                                                     I                          Z2  9      02005040120050401        A                           
S0198001003INJECTION, PEGAPTANIB SODIUM, 0.3 MG                                            Inj pegaptanib 0.3 mg       00      9                                                                                                     I                          Z2  9      02005070120050701        A                           
S0199001003MEDICALLY INDUCED ABORTION BY ORAL INGESTION OF MEDICATION INCLUDING ALL        Med abortion inc all ex drug00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S0199002004ASSOCIATED SERVICES AND SUPPLIES (E.G., PATIENT COUNSELING, OFFICE VISITS,                                                                                                                                                                                                                                           
S0199003004CONFIRMATION OF PREGNANCY BY HCG, ULTRASOUND TO CONFIRM DURATION OF PREGNANCY,                                                                                                                                                                                                                                       
S0199004004ULTRASOUND TO CONFIRM COMPLETION OF ABORTION) EXCEPT DRUGS                                                                                                                                                                                                                                                           
S0201001003PARTIAL HOSPITALIZATION SERVICES, LESS THAN 24 HOURS, PER DIEM                  Partial hospitalization serv00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S0206001003PROCEDURE PERFORMED IN SURGERY SUITE IN PHYSICIAN'S OFFICE (LIST SEPARATELY IN  Surgery in office           00      9                                                                            MODSU                    I                      0088Z2  2      0200107012003010120021231N                           
S0206002004ADDITION TO CODE FOR PRIMARY PROCEDURE TO DENOTE USE OF FACILITY AND EQUIPMENT)                                                                                                                                                                                                                                      
S0207001003PARAMEDIC INTERCEPT, NON-HOSPITAL-BASED ALS SERVICE (NON-VOLUNTARY),            Paramedicintercep nonhospals00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S0207002004NON-TRANSPORT                                                                                                                                                                                                                                                                                                        
S0208001003PARAMEDIC INTERCEPT, HOSPITAL-BASED ALS SERVICE (NON-VOLUNTARY), NON-TRANSPORT  Paramed intrcept nonvol     00      9                                                                                                     I                      0088Z2  D      02002010120020101        N                           
S0209001003WHEELCHAIR VAN, MILEAGE, PER MILE                                               WC van mileage per mi       00      9                                                                                                     I                      0088Z2  D      02002010120020101        N                           
S0215001003NON-EMERGENCY TRANSPORTATION; MILEAGE, PER MILE                                 Nonemerg transp mileage     00      9                                                                                                     I                      0088Z2  D      02002010120020401        N                           
S0220001003MEDICAL CONFERENCE BY A PHYSICIAN WITH INTERDISCIPLINARY TEAM OF HEALTH         Medical conference by physic00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S0220002004PROFESSIONALS OR REPRESENTATIVES OF COMMUNITY AGENCIES TO COORDINATE ACTIVITIES                                                                                                                                                                                                                                      
S0220003004OF PATIENT CARE (PATIENT IS PRESENT); APPROXIMATELY 30 MINUTES                                                                                                                                                                                                                                                       
S0221001003MEDICAL CONFERENCE BY A PHYSICIAN WITH INTERDISCIPLINARY TEAM OF HEALTH         Medical conference, 60 min  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S0221002004PROFESSIONALS OR REPRESENTATIVES OF COMMUNITY AGENCIES TO COORDINATE ACTIVITIES                                                                                                                                                                                                                                      
S0221003004OF PATIENT CARE (PATIENT IS PRESENT); APPROXIMATELY 60 MINUTES                                                                                                                                                                                                                                                       
S0250001003COMPREHENSIVE GERIATRIC ASSESSMENT AND TREATMENT PLANNING PERFORMED BY          Comp geriatr assmt team     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0250002004ASSESSMENT TEAM                                                                                                                                                                                                                                                                                                      
S0255001003HOSPICE REFERRAL VISIT (ADVISING PATIENT AND FAMILY OF CARE OPTIONS) PERFORMED  Hospice refer visit nonmd   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0255002004BY NURSE, SOCIAL WORKER, OR OTHER DESIGNATED STAFF                                                                                                                                                                                                                                                                   
S0257001003COUNSELING AND DISCUSSION REGARDING ADVANCE DIRECTIVES OR END OF LIFE CARE      End of life counseling      00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
S0257002004PLANNING AND DECISIONS, WITH PATIENT AND/OR SURROGATE (LIST SEPARATELY IN                                                                                                                                                                                                                                            
S0257003004ADDITION TO CODE FOR APPROPRIATE EVALUATION AND MANAGEMENT SERVICE)                                                                                                                                                                                                                                                  
S0260001003HISTORY AND PHYSICAL (OUTPATIENT OR OFFICE) RELATED TO SURGICAL PROCEDURE (LIST H&P for surgery             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0260002004SEPARATELY IN ADDITION TO CODE FOR APPROPRIATE EVALUATION AND MANAGEMENT                                                                                                                                                                                                                                             
S0260003004SERVICE)                                                                                                                                                                                                                                                                                                             
S0265001003GENETIC COUNSELING, UNDER PHYSICIAN SUPERVISION, EACH 15 MINUTES                Genetic counsel 15 mins     00      9                                                                                                     I                          Z2  9      02005070120050701        A                           
S0302001003COMPLETED EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) SERVICE      Completed EPSDT             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0302002004(LIST IN ADDITION TO CODE FOR APPROPRIATE EVALUATION AND MANAGEMENT SERVICE)                                                                                                                                                                                                                                         
S0310001003HOSPITALIST SERVICES (LIST SEPARATELY IN ADDITION TO CODE FOR APPROPRIATE       Hospitalist visit           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0310002004EVALUATION AND MANAGEMENT SERVICE)                                                                                                                                                                                                                                                                                   
S0315001003DISEASE MANAGEMENT PROGRAM; INITIAL ASSESSMENT AND INITIATION OF THE PROGRAM    Disease management program  00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S0316001003FOLLOW-UP/REASSESSMENT                                                          Follow-up/reassessment      00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S0317001003DISEASE MANAGEMENT PROGRAM; PER DIEM                                            Disease mgmt per diem       00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S0320001003TELEPHONE CALLS BY A REGISTERED NURSE TO A DISEASE MANAGEMENT PROGRAM MEMBER    RN telephone calls to DMP   00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S0320002004FOR MONITORING PURPOSES; PER MONTH                                                                                                                                                                                                                                                                                   
S0340001003LIFESTYLE MODIFICATION PROGRAM FOR MANAGEMENT OF CORONARY ARTERY DISEASE,       Lifestyle mod 1st stage     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0340002004INCLUDING ALL SUPPORTIVE SERVICES; FIRST QUARTER / STAGE                                                                                                                                                                                                                                                             
S0341001003LIFESTYLE MODIFICATION PROGRAM FOR MANAGEMENT OF CORONARY ARTERY DISEASE,       Lifestyle mod 2 or 3 stage  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0341002004INCLUDING ALL SUPPORTIVE SERVICES; SECOND OR THIRD QUARTER / STAGE                                                                                                                                                                                                                                                   
S0342001003LIFESTYLE MODIFICATION PROGRAM FOR MANAGEMENT OF CORONARY ARTERY DISEASE,       Lifestyle mod 4th stage     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0342002004INCLUDING ALL SUPPORTIVE SERVICES; FOURTH QUARTER / STAGE                                                                                                                                                                                                                                                            
S0390001003ROUTINE FOOT CARE; REMOVAL AND/OR TRIMMING OF CORNS, CALLUSES AND/OR NAILS AND  Rout foot care per visit    00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S0390002004PREVENTIVE MAINTENANCE IN SPECIFIC MEDICAL CONDITIONS (E.G. DIABETES), PER VISIT                                                                                                                                                                                                                                     
S0395001003IMPRESSION CASTING OF A FOOT PERFORMED BY A PRACTITIONER OTHER THAN THE         Impression casting ft       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0395002004MANUFACTURER OF THE ORTHOTIC                                                                                                                                                                                                                                                                                         
S0400001003GLOBAL FEE FOR EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY TREATMENT OF KIDNEY        Global eswl kidney          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0400002004STONE(S)                                                                                                                                                                                                                                                                                                             
S0500001003DISPOSABLE CONTACT LENS, PER LENS                                               Dispos cont lens            00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0504001003SINGLE VISION PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS       Singl prscrp lens           00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0506001003BIFOCAL VISION PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS      Bifoc prscp lens            00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0508001003TRIFOCAL VISION PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS), PER LENS     Trifoc prscrp lens          00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0510001003NON-PRESCRIPTION LENS (SAFETY, ATHLETIC, OR SUNGLASS),  PER LENS                Non-prscrp lens             00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0512001003DAILY WEAR SPECIALTY CONTACT LENS, PER LENS                                     Daily cont lens             00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0514001003COLOR CONTACT LENS, PER LENS                                                    Color cont lens             00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0515001003SCLERAL LENS, LIQUID BANDAGE DEVICE, PER LENS                                   Scleral lens liquid bandage 00      9                                                                                                     I                          Z2  9      02004100120041001        N                           
S0516001003SAFETY EYEGLASS FRAMES                                                          Safety frames               00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0518001003SUNGLASSES FRAMES                                                               Sunglass frames             00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0580001003POLYCARBONATE LENS (LIST THIS CODE IN ADDITION TO THE BASIC CODE FOR THE LENS)  Polycarb lens               00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0581001003NONSTANDARD LENS (LIST THIS CODE IN ADDITION TO THE BASIC CODE FOR THE LENS)    Nonstnd lens                00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0590001003INTEGRAL LENS SERVICE, MISCELLANEOUS SERVICES REPORTED SEPARATELY               Misc integral lens serv     00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0592001003COMPREHENSIVE CONTACT LENS EVALUATION                                           Comp cont lens eval         00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0595001003DISPENSING NEW SPECTACLE LENSES FOR PATIENT SUPPLIED FRAME                      New lenses in pts old frame 00      9                                                                                                     I                          Z2  9      02005040120050401        A                           
S0601001003SCREENING PROCTOSCOPY                                                           Screening proctoscopy       00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S0605001003DIGITAL RECTAL EXAMINATION, ANNUAL                                              Digital rectal examination, 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S0610001003ANNUAL GYNECOLOGICAL EXAMINATION, NEW PATIENT                                   Annual gynecological examina00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S0612001003ANNUAL GYNECOLOGICAL EXAMINATION, ESTABLISHED PATIENT                           Annual gynecological examina00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S0613001003ANNUAL GYNECOLOGICAL EXAMINATION; CLINICAL BREAST EXAMINATION WITHOUT PELVIC    Ann breast exam             00      9                                                                                                     I                          Z2  9      02005070120050701        A                           
S0613002004EVALUATION                                                                                                                                                                                                                                                                                                           
S0618001003AUDIOMETRY FOR HEARING AID EVALUATION TO DETERMINE THE LEVEL AND DEGREE OF      Audiometry for hearing aid  00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S0618002004HEARING LOSS                                                                                                                                                                                                                                                                                                         
S0620001003ROUTINE OPHTHALMOLOGICAL EXAMINATION INCLUDING REFRACTION; NEW PATIENT          Routine ophthalmological exa00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S0621001003ROUTINE OPHTHALMOLOGICAL EXAMINATION INCLUDING REFRACTION; ESTABLISHED PATIENT  Routine ophthalmological exa00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S0622001003PHYSICAL EXAM FOR COLLEGE, NEW OR ESTABLISHED PATIENT (LIST SEPARATELY IN       Phys exam for college       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0622002004ADDITION TO APPROPRIATE EVALUATION AND MANAGEMENT CODE)                                                                                                                                                                                                                                                              
S0625001003RETINAL TELESCREENING BY DIGITAL IMAGING OF MULTIPLE DIFFERENT FUND US AREAS TO Digital screening retina    00      9                                                                                                     I                          Z2  9      02005040120050401        A                           
S0625002004SCREEN FOR VISION-THREATENING CONDITIONS, INCLUDING IMAGING, INTERPRETATION AND                                                                                                                                                                                                                                      
S0625003004REPORT                                                                                                                                                                                                                                                                                                               
S0630001003REMOVAL OF SUTURES; BY A PHYSICIAN OTHER THAN THE PHYSICIAN WHO ORIGINALLY      Removal of sutures          00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S0630002004CLOSED THE WOUND                                                                                                                                                                                                                                                                                                     
S0800001003LASER IN SITU KERATOMILEUSIS (LASIK)                                            Laser in situ keratomileusis00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S0810001003PHOTOREFRACTIVE KERATECTOMY (PRK)                                               Photorefractive keratectomy 00      9                                                                                                     I                      0088Z2  29     02000010120000101        N                           
S0812001003PHOTOTHERAPEUTIC KERATECTOMY (PTK)                                              Phototherap keratect        00      9                                                                                                     I                      0088Z2  Q      02001070120010701        N                           
S0820001003COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL                                     Computerized corneal topogra00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S0830001003ULTRASOUND PACHYMETRY TO DETERMINE CORNEAL THICKNESS, WITH INTERPRETATION AND   Ultrasound pachymetry       00      9                                                                                                     I                      0088Z2  9      0200101012004040120040331N                           
S0830002004REPORT, UNILATERAL                                                                                                                                                                                                                                                                                                   
S1001001003DELUXE ITEM, PATIENT AWARE (LIST IN ADDITION TO CODE FOR BASIC ITEM)            Deluxe item                 00      9                                                                                                     I                      0088Z2  P      02001070120010701        N                           
S1002001003CUSTOMIZED ITEM (LIST IN ADDITION TO CODE FOR BASIC ITEM)                       Custom item                 00      9                                                                                                     I                      0088Z2  P      02001070120010701        N                           
S1015001003IV TUBING EXTENSION SET                                                         IV tubing extension set     00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S1016001003NON-PVC (POLYVINYL CHLORIDE) INTRAVENOUS ADMINISTRATION SET, FOR USE WITH DRUGS Non-pvc intravenous administ00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S1016002004THAT ARE NOT STABLE IN PVC E.G. PACLITAXEL                                                                                                                                                                                                                                                                           
S1025001003INHALED NITRIC OXIDE FOR THE TREATMENT OF HYPOXIC RESPIRATORY FAILURE IN THE    Inhal nitric oxide neonate  00      9                                                                                                     I                      0088Z2  1      02002010120020101        N                           
S1025002004NEONATE; PER DIEM                                                                                                                                                                                                                                                                                                    
S1030001003CONTINUOUS NONINVASIVE GLUCOSE MONITORING DEVICE, PURCHASE (FOR PHYSICIAN       Gluc monitor purchase       00      9                                                                                                     I                      0088Z2  PR     02002010120020101        N                           
S1030002004INTERPRETATION OF DATA, USE CPT CODE)                                                                                                                                                                                                                                                                                
S1031001003CONTINUOUS NONINVASIVE GLUCOSE MONITORING DEVICE, RENTAL, INCLUDING SENSOR,     Gluc monitor rental         00      9                                                                                                     I                      0088Z2  APR    02002010120020101        N                           
S1031002004SENSOR REPLACEMENT, AND DOWNLOAD TO MONITOR (FOR PHYSICIAN INTERPRETATION OF                                                                                                                                                                                                                                         
S1031003004DATA, USE CPT CODE)                                                                                                                                                                                                                                                                                                  
S1040001003CRANIAL REMOLDING ORTHOSIS, RIGID, WITH SOFT INTERFACE MATERIAL, CUSTOM         Cranial remolding orthosis  00      9                                                                                                     I                          Z2  P      02002100120021001        N                           
S1040002004FABRICATED, INCLUDES FITTING AND ADJUSTMENT(S)                                                                                                                                                                                                                                                                       
S2053001003TRANSPLANTATION OF SMALL INTESTINE AND LIVER ALLOGRAFTS                         Transplantation of small int00      9                                                                                                     I                      0088Z2  29     02000010120000101        N                           
S2054001003TRANSPLANTATION OF MULTIVISCERAL ORGANS                                         Transplantation of multivisc00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2055001003HARVESTING OF DONOR MULTIVISCERAL ORGANS, WITH PREPARATION AND MAINTENANCE OF   Harvesting of donor multivis00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2055002004ALLOGRAFTS; FROM CADAVER DONOR                                                                                                                                                                                                                                                                                       
S2060001003LOBAR LUNG TRANSPLANTATION                                                      Lobar lung transplantation  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2061001003DONOR LOBECTOMY (LUNG) FOR TRANSPLANTATION, LIVING DONOR                        Donor lobectomy (lung)      00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2065001003SIMULTANEOUS PANCREAS KIDNEY TRANSPLANTATION                                    Simult panc kidn trans      00      9                                                                                                     I                      0088Z2  2      02001070120010701        N                           
S2068001003BREAST RECONSTRUCTION WITH DEEP INFERIOR EPIGASTRIC PERFORATOR (DIEP) FLAP,     Breast DIEP flap reconstruct00      9                                                                                                     I                          Z2  9      02006010120060101        A                           
S2068002004INCLUDING MICROVASCULAR ANASTOMOSIS AND CLOSURE OF DONOR SITE, UNILATERAL                                                                                                                                                                                                                                            
S2070001003CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH ENDOSCOPIC LASER   Cysto laser tx ureteral calc00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S2070002004TREATMENT OF URETERAL CALCULI (INCLUDES URETERAL CATHETERIZATION)                                                                                                                                                                                                                                                    
S2075001003LAPAROSCOPY, SURGICAL; REPAIR INCISIONAL OR VENTRAL HERNIA                      Lap inc/vent hernia repair  00      9                                                                                                     I                          Z2  9      02005100120051001        A                           
S2076001003LAPAROSCOPY, SURGICAL; REPAIR UMBILICAL HERNIA                                  Lap umbilical hernia repair 00      9                                                                                                     I                          Z2  9      02005100120051001        A                           
S2077001003LAPAROSCOPY, SURGICAL; IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR INCISIONAL  Lap mesh implant hern rep   00      9                                                                                                     I                          Z2  9      02005100120051001        A                           
S2077002004OR VENTRAL HERNIA REPAIR (LIST SEPARATELY IN ADDITION TO CODE FOR INCISIONAL OR                                                                                                                                                                                                                                      
S2077003004VENTRAL HERNIA REPAIR)                                                                                                                                                                                                                                                                                               
S2078001003LAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY (SUBTOTAL HYSTERECTOMY), WITH OR        Lap supracerv hysterectomy  00      9                                                                                                     I                          Z2  9      02006010120060101        A                           
S2078002004WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S)                                                                                                                                                                                                                                                      
S2079001003LAPAROSCOPIC ESOPHAGOMYOTOMY (HELLER TYPE)                                      Lap esophagomyotomy         00      9                                                                                                     I                          Z2  9      02006010120060101        A                           
S2080001003LASER-ASSISTED UVULOPALATOPLASTY (LAUP)                                         Laup                        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2082001003LAPAROSCOPY, SURGICAL; GASTRIC RESTRICTIVE PROCEDURE, ADJUSTABLE GASTRIC BAND   Lap adjustable gastric band 00      9                                                                                                     I                          Z2  9      0200404012006010120051231D                           
S2082002004(INCLUDES PLACEMENT OF SUBCUTANEOUS PORT)                                                                                                                                                                                                                                                                            
S2083001003ADJUSTMENT OF GASTRIC BAND DIAMETER VIA SUBCUTANEOUS PORT BY INJECTION OR       Adjustment gastric band     00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S2083002004ASPIRATION OF SALINE                                                                                                                                                                                                                                                                                                 
S2085001003LAPAROSCOPY, GASTRIC RESTRICTIVE PROCEDURE, WITH GASTRIC BYPASS FOR MORBID      Laparoscop gastric bypass   00      9                                                                                                     I                          Z2  9      0200401012005010120041231N                           
S2085002004OBESITY, WITH SHORT LIMB (LESS THAN 100 CM) ROUX-EN-Y GASTROENTEROSTOMY                                                                                                                                                                                                                                              
S2090001003ABLATION, OPEN, ONE OR MORE RENAL TUMOR(S); CRYOSURGICAL                        Open cryosurg renal         00      9                                                                                                     I                          Z2  9      0200304012006010120051231D                           
S2091001003ABLATION, PERCUTANEOUS, ONE OR MORE RENAL TUMOR(S); CRYOSURGICAL                Perc cryosurg renal         00      9                                                                                                     I                          Z2  9      0200304012006010120051231D                           
S2095001003TRANSCATHETER OCCLUSION OR EMBOLIZATION FOR TUMOR DESTRUCTION, PERCUTANEOUS,    Transcath emboliz microspher00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
S2095002004ANY METHOD, USING YTTRIUM-90 MICROSPHERES                                                                                                                                                                                                                                                                            
S2102001003ISLET CELL TISSUE TRANSPLANT FROM PANCREAS; ALLOGENEIC                          Islet cell tissue transplant00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2103001003ADRENAL TISSUE TRANSPLANT TO BRAIN                                              Adrenal tissue transplant   00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2107001003ADOPTIVE IMMUNOTHERAPY I.E. DEVELOPMENT OF SPECIFIC ANTI-TUMOR REACTIVITY (E.G. Adoptive immunotherapy      00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S2107002004TUMOR-INFILTRATING LYMPHOCYTE THERAPY) PER COURSE OF TREATMENT                                                                                                                                                                                                                                                       
S2112001003ARTHROSCOPY, KNEE, SURGICAL FOR HARVESTING OF CARTILAGE (CHONDROCYTE CELLS)     Knee arthroscp harv         00      9                                                                                                     I                      0088Z2  2      02001070120010701        N                           
S2113001003ARTHROSCOPY, KNEE, SURGICAL FOR IMPLANTATION OF CULTURED ANALOGOUS CHONDROCYTES Arthro chondrocyte implant  00      9                                                                                                     I                          Z2  9      0200401012005010120041231N                           
S2114001003ARTHROSCOPY, SHOULDER, SURGICAL; TENODESIS OF BICEPS                            Arthrosc sh tenodesis biceps00      9                                                                                                     I                          Z2  9      02005100120051001        A                           
S2115001003OSTEOTOMY, PERIACETABULAR, WITH INTERNAL FIXATION                               Periacetabular osteotomy    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2117001003ARTHROEREISIS, SUBTALAR                                                         Arthroereisis, subtalar     00      9                                                                                                     I                          Z2  9      02005100120051001        A                           
S2120001003LOW DENSITY LIPOPROTEIN (LDL) APHERESIS USING HEPARIN-INDUCED EXTRACORPOREAL    Low density lipoprotein(LDL)00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2120002004LDL PRECIPITATION                                                                                                                                                                                                                                                                                                    
S2130001003ENDOLUMINAL RADIOFREQUENCY ABLATION OF REFLUXING SAPHENOUS VEINS                Endo RF ablation saph vein  00      9                                                                                                     I                          Z2  9      0200301012005010120041231N                           
S2131001003ENDOVASCULAR LASER ABLATION OF LONG OR SHORT SAPHENOUS VEIN, WITH OR WITHOUT    Laser ablat saphenous vein  00      9                                                                                                     I                          Z2  9      0200404012005010120041231N                           
S2131002004PROXIMAL LIGATION OR DIVISION                                                                                                                                                                                                                                                                                        
S2135001003NEUROLYSIS, BY INJECTION, OF METATARSAL NEUROMA/INTERDIGITAL NEURITIS, ANY      Neurolysis interspace foot  00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
S2135002004INTERSPACE OF THE FOOT                                                                                                                                                                                                                                                                                               
S2140001003CORD BLOOD HARVESTING FOR TRANSPLANTATION, ALLOGENEIC                           Cord blood harvesting       00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2142001003CORD BLOOD-DERIVED STEM-CELL TRANSPLANTATION, ALLOGENEIC                        Cord blood-derived stem-cell00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2150001003BONE MARROW OR BLOOD-DERIVED STEM CELLS (PERIPHERAL OR UMBILICAL), ALLOGENEIC   BMT harv/transpl 28d pkg    00      9                                                                                                     I                      0088Z2  9      02002010120040401        N                           
S2150002004OR AUTOLOGOUS, HARVESTING, TRANSPLANTATION, AND RELATED COMPLICATIONS;                                                                                                                                                                                                                                               
S2150003004INCLUDING: PHERESIS AND CELL PREPARATION/STORAGE; MARROW ABLATIVE THERAPY;                                                                                                                                                                                                                                           
S2150004004DRUGS, SUPPLIES, HOSPITALIZATION WITH OUTPATIENT FOLLOW-UP; MEDICAL/SURGICAL,                                                                                                                                                                                                                                        
S2150005004DIAGNOSTIC, EMERGENCY, AND REHABILITATIVE SERVICES; AND THE NUMBER OF DAYS OF                                                                                                                                                                                                                                        
S2150006004PRE-AND POST-TRANSPLANT CARE IN THE GLOBAL DEFINITION                                                                                                                                                                                                                                                                
S2152001003SOLID ORGAN(S), COMPLETE OR SEGMENTAL, SINGLE ORGAN OR COMBINATION OF ORGANS;   Solid organ transpl pkg     00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S2152002004DECEASED OR LIVING DONOR (S), PROCUREMENT, TRANSPLANTATION, AND RELATED                                                                                                                                                                                                                                              
S2152003004COMPLICATIONS; INCLUDING: DRUGS; SUPPLIES; HOSPITALIZATION WITH OUTPATIENT                                                                                                                                                                                                                                           
S2152004004FOLLOW-UP; MEDICAL/SURGICAL, DIAGNOSTIC, EMERGENCY, AND REHABILITATIVE                                                                                                                                                                                                                                               
S2152005004SERVICES, AND THE NUMBER OF DAYS OF PRE- AND POST-TRANSPLANT CARE IN THE GLOBAL                                                                                                                                                                                                                                      
S2152006004DEFINITION                                                                                                                                                                                                                                                                                                           
S2180001003DONOR LEUKOCYTE INFUSION (E.G. DLI, DONOR LYMPHOCYTE INFUSION, DONOR BUFFY COAT Donor leukocyte infusion    00      9                                                                            38242                    I                      0088Z2  9      0200101012003010120021231N                           
S2180002004CELL TRANSFUSION, DONOR PERIPHERAL BLOOD MONOCYTE TRANSFUSION)                                                                                                                                                                                                                                                       
S2202001003ECHOSCLEROTHERAPY                                                               Echosclerotherapy           00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2205001003MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2205002004MINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S2205003004USING ARTERIAL GRAFT(S), SINGLE CORONARY ARTERIAL GRAFT                                                                                                                                                                                                                                                              
S2206001003MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2206002004MINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S2206003004USING ARTERIAL GRAFT(S), TWO CORONARY ARTERIAL GRAFTS                                                                                                                                                                                                                                                                
S2207001003MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2207002004MINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S2207003004USING VENOUS GRAFT ONLY, SINGLE CORONARY VENOUS GRAFT                                                                                                                                                                                                                                                                
S2208001003MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2208002004MINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S2208003004USING SINGLE ARTERIAL AND VENOUS GRAFT(S), SINGLE VENOUS GRAFT                                                                                                                                                                                                                                                       
S2209001003MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS SURGERY INVOLVING              Minimally invasive direct co00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2209002004MINI-THORACOTOMY OR MINI-STERNOTOMY SURGERY, PERFORMED UNDER DIRECT VISION;                                                                                                                                                                                                                                          
S2209003004USING TWO ARTERIAL GRAFTS AND SINGLE VENOUS GRAFT                                                                                                                                                                                                                                                                    
S2211001003TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), CAROTID ARTERY,              Transv carotid stent placemt00      9                                                                                                     I                          Z2  9      0200204012005010120041231N                           
S2211002004PERCUTANEOUS, UNILATERAL (IF PERFORMED BILATERALLY, USE-50 MODIFIER)                                                                                                                                                                                                                                                 
S2213001003IMPLANTATION OF GASTRIC ELECTRICAL STIMULATION DEVICE                           Implant gastric stim        00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S2215001003UPPER GASTROINTESTINAL ENDOSCOPY, INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE  UGI endoscopy inj implant   00      9                                                                                                     I                          Z2  9      0200410012006010120051231D                           
S2215002004DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH INJECTION OF IMPLANT MATERIAL INTO                                                                                                                                                                                                                                      
S2215003004AND ALONG THE MUSCLE OF THE LOWER ESOPHAGEAL SPHINCTER FOR TREATMENT OF                                                                                                                                                                                                                                              
S2215004004GASTROESOPHAGEAL REFLUX DISEASE                                                                                                                                                                                                                                                                                      
S2225001003MYRINGOTOMY, LASER-ASSISTED                                                     Myringotomy laser-assist    00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
S2230001003IMPLANTATION OF MAGNETIC COMPONENT OF SEMI-IMPLANTABLE HEARING DEVICE ON        Implant semi-imp hear       00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S2230002004OSSICLES IN MIDDLE EAR                                                                                                                                                                                                                                                                                               
S2235001003IMPLANTATION OF AUDITORY BRAIN STEM IMPLANT                                     Implant auditory brain imp  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S2250001003UTERINE ARTERY EMBOLIZATION FOR UTERINE FIBROIDS                                Uterine artery emboliz      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2255001003HYSTEROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BILATERALLY BY MICRO-INSERTS Hysterosc oviduct occlus    00      9                                                                                                     I                          Z2  9      0200404012005010120041231N                           
S2255002004FOR PERMANENT STERILIZATION                                                                                                                                                                                                                                                                                          
S2260001003INDUCED ABORTION, 17 TO 24 WEEKS, ANY SURGICAL METHOD                           Induced abortion 17-24 weeks00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2262001003ABORTION FOR MATERNAL INDICATION, 25 WEEKS OR GREATER                           Abortion maternal indic>=25w00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S2265001003ABORTION FOR FETAL INDICATION, 25-28 WEEKS                                      Abortion 25-28wks fetal indi00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S2266001003ABORTION FOR FETAL INDICATION, 29-31 WEEKS                                      Abortion 29-31wks fetal indi00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S2267001003ABORTION FOR FETAL INDICATION, 32 WEEKS OR GREATER                              Abortion >=32wks fetal indic00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S2300001003ARTHROSCOPY, SHOULDER, SURGICAL; WITH THERMALLY-INDUCED CAPSULORRHAPHY          Arthroscopy, shoulder, surgi00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2340001003CHEMODENERVATION OF ABDUCTOR MUSCLE(S) OF VOCAL CORD                            Chemodenervation of abductor00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2341001003CHEMODENERVATION OF ADDUCTOR MUSCLE(S) OF VOCAL CORD                            Chemodenerv adduct vocal    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2342001003NASAL ENDOSCOPY FOR POST-OPERATIVE DEBRIDEMENT FOLLOWING FUNCTIONAL ENDOSCOPIC  Nasal endoscop po debrid    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2342002004SINUS SURGERY, NASAL AND/OR SINUS CAVITY(S), UNILATERAL OR BILATERAL                                                                                                                                                                                                                                                 
S2348001003DECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL    Decompress disc RF lumbar   00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
S2348002004DISC, USING RADIOFREQUENCY ENERGY, SINGLE OR MULTIPLE LEVELS, LUMBAR                                                                                                                                                                                                                                                 
S2350001003DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S),   Diskectomy, anterior, with d00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2350002004INCLUDING OSTEOPHYTECTOMY; LUMBAR, SINGLE INTERSPACE                                                                                                                                                                                                                                                                 
S2351001003DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S),   Diskectomy, anterior, with d00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2351002004INCLUDING OSTEOPHYTECTOMY; LUMBAR, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY                                                                                                                                                                                                                                       
S2351003004IN ADDITION TO CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                           
S2360001003PERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL        Vertebroplast cerv 1st      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2360002004INJECTION; CERVICAL                                                                                                                                                                                                                                                                                                  
S2361001003EACH ADDITIONAL CERVICAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE    Vertebroplast cerv addl     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2361002004FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                               
S2362001003KYPHOPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION              Kyphoplasty, first vertebra 00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
S2363001003KYPHOPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; EACH        Kyphoplasty, each addl      00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
S2363002004ADDITIONAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY                                                                                                                                                                                                                                           
S2363003004PROCEDURE)                                                                                                                                                                                                                                                                                                           
S2370001003INTRADISCAL ELECTROTHERMAL THERAPY; SINGLE INTERSPACE                           Intradiscal electrothermal  00      9                                                                                                     I                      0088Z2  9      0200101012004100120040930N                           
S2371001003EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY     Each additional interspace  00      9                                                                                                     I                      0088Z2  9      0200101012004100120040930N                           
S2371002004PROCEDURE)                                                                                                                                                                                                                                                                                                           
S2400001003REPAIR, CONGENITAL DIAPHRAGMATIC HERNIA IN THE FETUS USING TEMPORARY TRACHEAL   Fetal surg congen hernia    00      9                                                                                                     I                      0088Z2  2      02002010120020401        N                           
S2400002004OCCLUSION, PROCEDURE PERFORMED IN UTERO                                                                                                                                                                                                                                                                              
S2401001003REPAIR, URINARY TRACT OBSTRUCTION IN THE FETUS, PROCEDURE PERFORMED IN UTERO    Fetal surg urin trac obstr  00      9                                                                                                     I                      0088Z2  2      02002010120020101        N                           
S2402001003REPAIR, CONGENITAL CYSTIC ADENOMATOID MALFORMATION IN THE FETUS, PROCEDURE      Fetal surg cong cyst malf   00      9                                                                                                     I                      0088Z2  2      02002010120020101        N                           
S2402002004PERFORMED IN UTERO                                                                                                                                                                                                                                                                                                   
S2403001003REPAIR, EXTRALOBAR PULMONARY SEQUESTRATION IN THE FETUS, PROCEDURE PERFORMED IN Fetal surg pulmon sequest   00      9                                                                                                     I                      0088Z2  2      02002010120020101        N                           
S2403002004UTERO                                                                                                                                                                                                                                                                                                                
S2404001003REPAIR, MYELOMENINGOCELE IN THE FETUS, PROCEDURE PERFORMED IN UTERO             Fetal surg myelomeningo     00      9                                                                                                     I                      0088Z2  2      02002010120020101        N                           
S2405001003REPAIR OF SACROCOCCYGEAL TERATOMA IN THE FETUS, PROCEDURE PERFORMED IN UTERO    Fetal surg sacrococ teratoma00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S2409001003REPAIR, CONGENITAL MALFORMATION OF FETUS, PROCEDURE PERFORMED IN UTERO, NOT     Fetal surg noc              00      9                                                                                                     I                      0088Z2  2      02002010120020101        N                           
S2409002004OTHERWISE CLASSIFIED                                                                                                                                                                                                                                                                                                 
S2411001003FETOSCOPIC LASER THERAPY FOR TREATMENT OF TWIN-TO-TWIN TRANSFUSION SYNDROME     Fetoscop laser ther TTTS    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2900001003SURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY   Robotic surgical system     00      9                                                                                                     I                          Z2  9      02005070120050701        A                           
S2900002004IN ADDITION TO CODE FOR PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                           
S3000001003DIABETIC INDICATOR; RETINAL EYE EXAM, DILATED, BILATERAL                        Bilat dil retinal exam      00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S3005001003PERFORMANCE MEASUREMENT, EVALUATION OF PATIENT SELF ASSESSMENT, DEPRESSION      Eval self-assess depression 00      9                                                                                                     I                          Z2  9      02005040120050401        A                           
S3600001003STAT LABORATORY REQUEST (SITUATIONS OTHER THAN S3601)                           Stat lab                    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S3601001003EMERGENCY STAT LABORATORY CHARGE FOR PATIENT WHO IS HOMEBOUND OR RESIDING  IN A Stat lab home/nf            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S3601002004NURSING FACILITY                                                                                                                                                                                                                                                                                                     
S3620001003NEWBORN METABOLIC SCREENING PANEL, INCLUDES TEST KIT, POSTAGE AND THE           Newborn metabolic screening 00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S3620002004LABORATORY TESTS SPECIFIED BY THE STATE FOR INCLUSION IN THIS PANEL (E.G.                                                                                                                                                                                                                                            
S3620003004GALACTOSE; HEMOGLOBIN, ELECTROPHORESIS;  HYDROXYPROGESTERONE, 17-D; PHENYLANINE                                                                                                                                                                                                                                      
S3620004004(PKU); AND THYROXINE, TOTAL)                                                                                                                                                                                                                                                                                         
S3625001003MATERNAL SERUM TRIPLE MARKER SCREEN INCLUDING ALPHA-FETOPROTEIN (AFP), ESTRIOL, Maternal triple screen test 00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3625002004AND HUMAN CHORIONIC GONADOTROPIN (HCG)                                                                                                                                                                                                                                                                               
S3626001003MATERNAL SERUM QUADRUPLE MARKER SCREEN INCLUDING ALPHA-FETOPROTEIN (AFP),       Maternal serum quad screen  00      9                                                                                                     I                          Z2  9      02005100120051001        A                           
S3626002004ESTRIOL, HUMAN CHORIONIC GONADOTROPIN (HCG) AND INHIBIN A                                                                                                                                                                                                                                                            
S3630001003EOSINOPHIL COUNT, BLOOD, DIRECT                                                 Eosinophil blood count      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S3645001003HIV-1 ANTIBODY TESTING OF ORAL MUCOSAL TRANSUDATE                               HIV-1 antibody testing of or00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S3650001003SALIVA TEST, HORMONE LEVEL; DURING MENOPAUSE                                    Saliva test, hormone level; 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S3652001003SALIVA TEST, HORMONE LEVEL; TO ASSESS PRETERM LABOR RISK                        Saliva test, hormone level; 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S3655001003ANTISPERM ANTIBODIES TEST (IMMUNOBEAD)                                          Antisperm antibodies test   00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S3701001003IMMUNOASSAY FOR NUCLEAR MATRIX PROTEIN 22 (NMP-22), QUANTITATIVE                NMP-22 assay                00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S3708001003GASTROINTESTINAL FAT ABSORPTION STUDY                                           Gastrointestinal fat absorpt00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S3818001003COMPLETE GENE SEQUENCE ANALYSIS; BRCA1 GENE                                     BRCA1 gene anal             00      9                                                                                                     I                      0088Z2  5      02001070120010701        N                           
S3819001003COMPLETE GENE SEQUENCE ANALYSIS; BRCA2 GENE                                     BRCA2 gene anal             00      9                                                                                                     I                      0088Z2  5      02001070120010701        N                           
S3820001003COMPLETE BRCA1 AND BRCA2 GENE SEQUENCE ANALYSIS FOR SUSCEPTIBILITY TO BREAST    Comp BRCA1/BRCA2            00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S3820002004AND OVARIAN CANCER                                                                                                                                                                                                                                                                                                   
S3822001003SINGLE MUTATION ANALYSIS (IN INDIVIDUAL WITH A KNOWN BRCA1 OR BRCA2 MUTATION IN Sing mutation brst/ovar     00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S3822002004THE FAMILY) FOR SUSCEPTIBILITY TO BREAST AND OVARIAN CANCER                                                                                                                                                                                                                                                          
S3823001003THREE-MUTATION BRCA1 AND BRCA2 ANALYSIS FOR SUSCEPTIBILITY TO BREAST AND        3 mutation brst/ovar        00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S3823002004OVARIAN CANCER IN ASHKENAZI INDIVIDUALS                                                                                                                                                                                                                                                                              
S3828001003COMPLETE GENE SEQUENCE ANALYSIS; MLH1 GENE                                      Comp MLH1 gene              00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S3829001003COMPLETE GENE SEQUENCE ANALYSIS; MLH2 GENE                                      Comp MLH2 gene              00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S3830001003COMPLETE MLH1 AND MLH2 GENE SEQUENCE ANALYSIS FOR HEREDITARY NONPOLYPOSIS       Gene test HNPCC comp        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S3830002004COLORECTAL CANCER (HNPCC) GENETIC TESTING                                                                                                                                                                                                                                                                            
S3831001003SINGLE-MUTATION ANALYSIS (IN INDIVIDUAL WITH A KNOWN MLH1 AND MLH2 MUTATION IN  Gene test HNPCC single      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S3831002004THE FAMILY) FOR HEREDITARY NONPOLYPOSIS COLORECTAL CANCER (HNPCC) GENETIC                                                                                                                                                                                                                                            
S3831003004TESTING                                                                                                                                                                                                                                                                                                              
S3833001003COMPLETE APC GENE SEQUENCE ANALYSIS FOR SUSCEPTIBILITY TO FAMILIAL ADENOMATOUS  Comp APC sequence           00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S3833002004POLYPOSIS (FAP) AND ATTENUATED FAP                                                                                                                                                                                                                                                                                   
S3834001003SINGLE-MUTATION ANALYSIS (IN INDIVIDUAL WITH A KNOWN APC MUTATION IN THE        Sing mutation APC           00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S3834002004FAMILY) FOR SUSCEPTIBILITY TO FAMILIAL ADENOMATOUS POLYPOSIS (FAP) AND                                                                                                                                                                                                                                               
S3834003004ATTENUATED FAP                                                                                                                                                                                                                                                                                                       
S3835001003COMPLETE GENE SEQUENCE ANALYSIS FOR CYSTIC FIBROSIS GENETIC TESTING             Gene test cystic fibrosis   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S3837001003COMPLETE GENE SEQUENCE ANALYSIS FOR HEMOCHROMATOSIS GENETIC TESTING             Gene test hemochromato      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S3840001003DNA ANALYSIS FOR GERMLINE MUTATIONS OF THE RET PROTO-ONCOGENE FOR               DNA analysis RET-oncogene   00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3840002004SUSCEPTIBILITY TO MULTIPLE ENDOCRINE NEOPLASIA TYPE 2                                                                                                                                                                                                                                                                
S3841001003GENETIC TESTING FOR RETINOBLASTOMA                                              Gene test retinoblastoma    00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3842001003GENETIC TESTING FOR VON HIPPEL-LINDAU DISEASE                                   Gene test Hippel-Lindau     00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3843001003DNA ANALYSIS OF THE F5 GENE FOR SUSCEPTIBILITY TO FACTOR V LEIDEN THROMBOPHILIA DNA analysis factor v       00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3844001003DNA ANALYSIS OF THE CONNEXIN 26 GENE (GJB2) FOR SUSCEPTIBILITY TO CONGENITAL,   DNA analysis deafness       00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3844002004PROFOUND DEAFNESS                                                                                                                                                                                                                                                                                                    
S3845001003GENETIC TESTING FOR ALPHA-THALASSEMIA                                           Gene test alpha-thalassemia 00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3846001003GENETIC TESTING FOR HEMOGLOBIN E BETA-THALASSEMIA                               Gene test beta-thalassemia  00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3847001003GENETIC TESTING FOR TAY-SACHS DISEASE                                           Gene test Tay-Sachs         00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3848001003GENETIC TESTING FOR GAUCHER DISEASE                                             Gene test Gaucher           00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3849001003GENETIC TESTING FOR NIEMANN-PICK DISEASE                                        Gene test Niemann-Pick      00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3850001003GENETIC TESTING FOR SICKLE CELL ANEMIA                                          Gene test sickle cell       00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3851001003GENETIC TESTING FOR CANAVAN DISEASE                                             Gene test canavan           00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3852001003DNA ANALYSIS FOR APOE EPSILON 4 ALLELE FOR SUSCEPTIBILITY TO ALZHEIMER'S DISEASEDNA analysis APOE alzheimer 00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S3853001003GENETIC TESTING FOR MYOTONIC MUSCULAR DYSTROPHY                                 Gene test myo musclr dyst   00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
S3854001003GENE EXPRESSION PROFILING PANEL FOR USE IN THE MANAGEMENT OF BREAST CANCER      Gene profile panel breast   00      9                                                                                                     I                          Z2  9      02006010120060101        A                           
S3854002004TREATMENT                                                                                                                                                                                                                                                                                                            
S3890001003DNA ANALYSIS, FECAL, FOR COLORECTAL CANCER SCREENING                            Fecal DNA analysis          00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S3900001003SURFACE ELECTROMYOGRAPHY (EMG)                                                  Surface EMG                 00      9                                                                                                     I                      0088Z2  9      02001070120010701        N                           
S3902001003BALLISTOCARDIOGRAM                                                              Ballistocardiogram          00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S3904001003MASTERS TWO STEP                                                                Masters two step            00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S4005001003INTERIM LABOR FACILITY GLOBAL (LABOR OCCURRING BUT NOT RESULTING IN DELIVERY)   Interim labor facility globa00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4011001003IN VITRO FERTILIZATION; INCLUDING BUT NOT LIMITED TO IDENTIFICATION AND         IVF package                 00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4011002004INCUBATION OF MATURE OOCYTES, FERTILIZATION WITH SPERM, INCUBATION OF                                                                                                                                                                                                                                                
S4011003004EMBRYO(S), AND SUBSEQUENT VISUALIZATION FOR DETERMINATION OF DEVELOPMENT                                                                                                                                                                                                                                             
S4013001003COMPLETE CYCLE, GAMETE INTRAFALLOPIAN TRANSFER (GIFT), CASE RATE                Compl GIFT case rate        00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4014001003COMPLETE CYCLE, ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT), CASE RATE                Compl ZIFT case rate        00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4015001003COMPLETE IN VITRO FERTILIZATION CYCLE, NOT OTHERWISE SPECIFIED, CASE RATE       Complete IVF nos case rate  00      9                                                                                                     I                      0088Z2  9      02002010120020401        N                           
S4016001003FROZEN IN VITRO FERTILIZATION CYCLE, CASE RATE                                  Frozen IVF case rate        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4017001003INCOMPLETE CYCLE, TREATMENT CANCELLED PRIOR TO STIMULATION, CASE RATE           IVF canc a stim case rate   00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4018001003FROZEN EMBRYO TRANSFER PROCEDURE CANCELLED BEFORE TRANSFER, CASE RATE           F EMB trns canc case rate   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4020001003IN VITRO FERTILIZATION PROCEDURE CANCELLED BEFORE ASPIRATION, CASE RATE         IVF canc a aspir case rate  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4021001003IN VITRO FERTILIZATION PROCEDURE CANCELLED AFTER ASPIRATION, CASE RATE          IVF canc p aspir case rate  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4022001003ASSISTED OOCYTE FERTILIZATION, CASE RATE                                        Asst oocyte fert case rate  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4023001003DONOR EGG CYCLE, INCOMPLETE, CASE RATE                                          Incompl donor egg case rate 00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4025001003DONOR SERVICES FOR IN VITRO FERTILIZATION (SPERM OR EMBRYO), CASE RATE          Donor serv IVF case rate    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4026001003PROCUREMENT OF DONOR SPERM FROM SPERM BANK                                      Procure donor sperm         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4027001003STORAGE OF PREVIOUSLY FROZEN EMBRYOS                                            Store prev froz embryos     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4028001003MICROSURGICAL EPIDIDYMAL SPERM ASPIRATION (MESA)                                Microsurg epi sperm asp     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4030001003SPERM PROCUREMENT AND CRYOPRESERVATION SERVICES; INITIAL VISIT                  Sperm procure init visit    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4031001003SPERM PROCUREMENT AND CRYOPRESERVATION SERVICES; SUBSEQUENT VISIT               Sperm procure subs visit    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4035001003STIMULATED INTRAUTERINE INSEMINATION (IUI), CASE RATE                           Stimulated IUI case rate    00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4036001003INTRAVAGINAL CULTURE (IVC), CASE RATE                                           Intravag cult case rate     00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4037001003CRYOPRESERVED EMBRYO TRANSFER, CASE RATE                                        Cryo embryo transf case rate00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4040001003MONITORING AND STORAGE OF CRYOPRESERVED EMBRYOS, PER 30 DAYS                    Monit store cryo embryo 30 d00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4042001003MANAGEMENT OF OVULATION INDUCTION (INTERPRETATION OF DIAGNOSTIC TESTS AND       Ovulation mgmt per cycle    00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
S4042002004STUDIES, NON-FACE-TO-FACE MEDICAL MANAGEMENT OF THE PATIENT), PER CYCLE                                                                                                                                                                                                                                              
S4981001003INSERTION OF LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM                       Insert levonorgestrel ius   00      9                                                                                                     I                      0088Z2  2      02001070120010701        N                           
S4989001003CONTRACEPTIVE INTRAUTERINE DEVICE (E.G. PROGESTACERT IUD), INCLUDING IMPLANTS   Contracept IUD              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4989002004AND SUPPLIES                                                                                                                                                                                                                                                                                                         
S4990001003NICOTINE PATCHES, LEGEND                                                        Nicotine patch legend       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4991001003NICOTINE PATCHES, NON-LEGEND                                                    Nicotine patch nonlegend    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S4993001003CONTRACEPTIVE PILLS FOR BIRTH CONTROL                                           Contraceptive pills for bc  00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S4995001003SMOKING CESSATION GUM                                                           Smoking cessation gum       00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S5000001003PRESCRIPTION DRUG, GENERIC                                                      Prescription drug, generic  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S5001001003PRESCRIPTION DRUG, BRAND NAME                                                   Prescription drug,brand name00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S50100010035% DEXTROSE AND 0.45% NORMAL SALINE, 1000 ML                                    5% dextrose and 0.45% saline00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S50110010035% DEXTROSE IN LACTATED RINGER'S, 1000 ML                                       5% dextrose in lactated ring00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S50120010035% DEXTROSE WITH POTASSIUM CHLORIDE, 1000 ML                                    5% dextrose with potassium  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S50130010035% DEXTROSE/0.45% NORMAL SALINE WITH POTASSIUM CHLORIDE AND MAGNESIUM SULFATE,  5%dextrose/0.45%saline1000ml00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S50130020041000 ML                                                                                                                                                                                                                                                                                                              
S50140010035% DEXTROSE/0.45% NORMAL SALINE WITH POTASSIUM CHLORIDE AND MAGNESIUM SULFATE,  D5W/0.45NS w KCl and MGS04  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S50140020041500 ML                                                                                                                                                                                                                                                                                                              
S5035001003HOME INFUSION THERAPY, ROUTINE SERVICE OF INFUSION DEVICE (E.G. PUMP            HIT routine device maint    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5035002004MAINTENANCE)                                                                                                                                                                                                                                                                                                         
S5036001003HOME INFUSION THERAPY, REPAIR OF INFUSION DEVICE (E.G. PUMP REPAIR)             HIT device repair           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5100001003DAY CARE SERVICES, ADULT; PER 15 MINUTES                                        Adult daycare services 15min00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5101001003DAY CARE SERVICES, ADULT; PER HALF DAY                                          Adult day care per half day 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5102001003DAY CARE SERVICES, ADULT; PER DIEM                                              Adult day care per diem     00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5105001003DAY CARE SERVICES, CENTER-BASED; SERVICES NOT INCLUDED IN PROGRAM FEE, PER DIEM Centerbased day care perdiem00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5108001003HOME CARE TRAINING TO HOME CARE CLIENT, PER 15 MINUTES                          Homecare train pt 15 min    00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S5109001003HOME CARE TRAINING TO HOME CARE CLIENT, PER SESSION                             Homecare train pt session   00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S5110001003HOME CARE TRAINING, FAMILY; PER 15 MINUTES                                      Family homecare training 15m00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5111001003HOME CARE TRAINING, FAMILY; PER SESSION                                         Family homecare train/sessio00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5115001003HOME CARE TRAINING, NON-FAMILY; PER 15 MINUTES                                  Nonfamily homecare train/15m00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5116001003HOME CARE TRAINING, NON-FAMILY; PER SESSION                                     Nonfamily HC train/session  00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5120001003CHORE SERVICES; PER 15 MINUTES                                                  Chore services per 15 min   00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5121001003CHORE SERVICES; PER DIEM                                                        Chore services per diem     00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5125001003ATTENDANT CARE SERVICES; PER 15 MINUTES                                         Attendant care service /15m 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5126001003ATTENDANT CARE SERVICES; PER DIEM                                               Attendant care service /diem00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5130001003HOMEMAKER SERVICE, NOS; PER 15 MINUTES                                          Homaker service nos per 15m 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5131001003HOMEMAKER SERVICE, NOS; PER DIEM                                                Homemaker service nos /diem 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5135001003COMPANION CARE, ADULT (E.G. IADL/ADL); PER 15 MINUTES                           Adult companioncare per 15m 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5136001003COMPANION CARE, ADULT (E.G. IADL/ADL); PER DIEM                                 Adult companioncare per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5140001003FOSTER CARE, ADULT; PER DIEM                                                    Adult foster care per diem  00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5141001003FOSTER CARE, ADULT; PER MONTH                                                   Adult foster care per month 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5145001003FOSTER CARE, THERAPEUTIC, CHILD; PER DIEM                                       Child fostercare th per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5146001003FOSTER CARE, THERAPEUTIC, CHILD; PER MONTH                                      Ther fostercare child /month00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5150001003UNSKILLED RESPITE CARE, NOT HOSPICE; PER 15 MINUTES                             Unskilled respite care /15m 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5151001003UNSKILLED RESPITE CARE, NOT HOSPICE; PER DIEM                                   Unskilled respitecare /diem 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5160001003EMERGENCY RESPONSE SYSTEM; INSTALLATION AND TESTING                             Emer response sys instal&tst00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5161001003EMERGENCY RESPONSE SYSTEM; SERVICE FEE, PER MONTH (EXCLUDES INSTALLATION AND    Emer rspns sys serv permonth00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5161002004TESTING)                                                                                                                                                                                                                                                                                                             
S5162001003EMERGENCY RESPONSE SYSTEM; PURCHASE ONLY                                        Emer rspns system purchase  00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5165001003HOME MODIFICATIONS; PER SERVICE                                                 Home modifications per serv 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5170001003HOME DELIVERED MEALS, INCLUDING PREPARATION; PER MEAL                           Homedelivered prepared meal 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5175001003LAUNDRY SERVICE, EXTERNAL, PROFESSIONAL; PER ORDER                              Laundry serv,ext,prof,/order00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5180001003HOME HEALTH RESPIRATORY THERAPY, INITIAL EVALUATION                             HH respiratory thrpy in eval00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5181001003HOME HEALTH RESPIRATORY THERAPY, NOS, PER DIEM                                  HH respiratory thrpy nos/day00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5185001003MEDICATION REMINDER SERVICE, NON-FACE-TO-FACE; PER MONTH                        Med reminder serv per month 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5190001003WELLNESS ASSESSMENT, PERFORMED BY NON-PHYSICIAN                                 Wellness assessment by nonph00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5199001003PERSONAL CARE ITEM, NOS, EACH                                                   Personal care item nos each 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S5497001003HOME INFUSION THERAPY, CATHETER CARE / MAINTENANCE, NOT OTHERWISE CLASSIFIED;   HIT cath care noc           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5497002004INCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S5497003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S5497004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S5498001003HOME INFUSION THERAPY, CATHETER CARE / MAINTENANCE, SIMPLE (SINGLE LUMEN),      HIT simple cath care        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5498002004INCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S5498003004COORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT, (DRUGS AND NURSING                                                                                                                                                                                                                                            
S5498004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S5501001003HOME INFUSION THERAPY, CATHETER CARE / MAINTENANCE, COMPLEX (MORE THAN ONE      HIT complex cath care       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5501002004LUMEN), INCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                       
S5501003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S5501004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S5502001003HOME INFUSION THERAPY, CATHETER CARE / MAINTENANCE, IMPLANTED ACCESS DEVICE,    HIT interim cath care       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5502002004INCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S5502003004COORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT, (DRUGS AND NURSING                                                                                                                                                                                                                                            
S5502004004VISITS CODED SEPARATELY), PER DIEM (USE THIS CODE FOR INTERIM MAINTENANCE OF                                                                                                                                                                                                                                         
S5502005004VASCULAR ACCESS NOT CURRENTLY IN USE)                                                                                                                                                                                                                                                                                
S5517001003HOME INFUSION THERAPY, ALL SUPPLIES NECESSARY FOR RESTORATION OF CATHETER       HIT declotting kit          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5517002004PATENCY OR DECLOTTING                                                                                                                                                                                                                                                                                                
S5518001003HOME INFUSION THERAPY, ALL SUPPLIES NECESSARY FOR CATHETER REPAIR               HIT cath repair kit         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5520001003HOME INFUSION THERAPY, ALL SUPPLIES (INCLUDING CATHETER) NECESSARY FOR A        HIT picc insert kit         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5520002004PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC) LINE INSERTION                                                                                                                                                                                                                                                  
S5521001003HOME INFUSION THERAPY, ALL SUPPLIES (INCLUDING CATHETER) NECESSARY FOR A        HIT midline cath insert kit 00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5521002004MIDLINE CATHETER INSERTION                                                                                                                                                                                                                                                                                           
S5522001003HOME INFUSION THERAPY, INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS        HIT picc insert no supp     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5522002004CATHETER (PICC), NURSING SERVICES ONLY (NO SUPPLIES OR CATHETER INCLUDED)                                                                                                                                                                                                                                            
S5523001003HOME INFUSION THERAPY, INSERTION OF MIDLINE CENTRAL VENOUS CATHETER, NURSING    HIP midline cath insert kit 00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S5523002004SERVICES ONLY (NO SUPPLIES OR CATHETER INCLUDED)                                                                                                                                                                                                                                                                     
S5550001003INSULIN, RAPID ONSET, 5 UNITS                                                   Insulin rapid 5 u           00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S5551001003INSULIN, MOST RAPID ONSET (LISPRO OR ASPART); 5 UNITS                           Insulin most rapid 5 u      00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S5552001003INSULIN, INTERMEDIATE ACTING (NPH OR LENTE); 5 UNITS                            Insulin intermed 5 u        00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S5553001003INSULIN, LONG ACTING; 5 UNITS                                                   Insulin long acting 5 u     00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S5560001003INSULIN DELIVERY DEVICE, REUSABLE PEN; 1.5 ML SIZE                              Insulin reuse pen 1.5 ml    00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S5561001003INSULIN DELIVERY DEVICE, REUSABLE PEN; 3 ML SIZE                                Insulin reuse pen 3 ml      00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S5565001003INSULIN CARTRIDGE FOR USE IN INSULIN DELIVERY DEVICE OTHER THAN PUMP; 150 UNITS Insulin cartridge 150 u     00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S5566001003INSULIN CARTRIDGE FOR USE IN INSULIN DELIVERY DEVICE OTHER THAN PUMP; 300 UNITS Insulin cartridge 300 u     00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S5570001003INSULIN DELIVERY DEVICE, DISPOSABLE PEN (INCLUDING INSULIN); 1.5 ML SIZE        Insulin dispos pen 1.5 ml   00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S5571001003INSULIN DELIVERY DEVICE, DISPOSABLE PEN (INCLUDING INSULIN); 3 ML SIZE          Insulin dispos pen 3 ml     00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S8002001003SUPPLY OF DIAGNOSTIC RADIOPHARMACEUTICAL, INDIUM-111                            Ibritumomab tiuxetan        00      9                                                                            A9522                    I                          Z2  1      0200210012003010120021231N                           
S8003001003SUPPLY OF THERAPEUTIC RADIOIMMUNOPHARMACEUTICAL, YTTRIUM-90                     Ibritumomab tiuxetan,perdose00      9                                                                            A9523                    I                          Z2  1      0200210012003010120021231N                           
S8004001003RADIOIMMUNOPHARMACEUTICAL LOCALIZATION OF TARGETED CELLS; WHOLE BODY            Wholebody radiopharm trgcell00      9                                                                            78804                    I                          Z2  9      0200301012005040120050331D                           
S8030001003SCLERAL APPLICATION OF TANTALUM RING(S) FOR LOCALIZATION OF LESIONS FOR PROTON  Tantalum ring application   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8030002004BEAM THERAPY                                                                                                                                                                                                                                                                                                         
S8035001003MAGNETIC SOURCE IMAGING                                                         Magnetic source imaging     00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S8037001003MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP)                              mrcp                        00      9                                                                                                     I                      0088Z2  4      02001070120010701        N                           
S8040001003TOPOGRAPHIC BRAIN MAPPING                                                       Topographic brain mapping   00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S8042001003MAGNETIC RESONANCE IMAGING (MRI), LOW-FIELD                                     MRI low field               00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S8049001003INTRAOPERATIVE RADIATION THERAPY (SINGLE ADMINISTRATION)                        Intraoperative radiation the00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S8055001003ULTRASOUND GUIDANCE FOR MULTIFETAL PREGNANCY REDUCTION(S), TECHNICAL COMPONENT  Us guidance fetal reduct    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8055002004(ONLY TO BE USED WHEN THE PHYSICIAN DOING THE REDUCTION PROCEDURE DOES NOT                                                                                                                                                                                                                                           
S8055003004PERFORM THE ULTRASOUND, GUIDANCE IS INCLUDED IN THE CPT CODE FOR MULTIFETAL                                                                                                                                                                                                                                          
S8055004004PREGNANCY REDUCTION - 59866)                                                                                                                                                                                                                                                                                         
S8075001003COMPUTER ANALYSIS OF FULL-FIELD DIGITAL MAMMOGRAM AND FURTHER PHYSICIAN REVIEW  CAD of digital mammogr      00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
S8075002004FOR INTERPRETATION, MAMMOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FOR                                                                                                                                                                                                                                             
S8075003004PRIMARY PROCEDURE)                                                                                                                                                                                                                                                                                                   
S8080001003SCINTIMAMMOGRAPHY (RADIOIMMUNOSCINTIGRAPHY OF THE BREAST), UNILATERAL,          Scintimammography           00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S8080002004INCLUDING SUPPLY OF RADIOPHARMACEUTICAL                                                                                                                                                                                                                                                                              
S8085001003FLUORINE-18 FLUORODEOXYGLUCOSE (F-18 FDG) IMAGING USING DUAL-HEAD COINCIDENCE   Fluorine-18 fluorodeoxygluco00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S8085002004DETECTION SYSTEM (NON-DEDICATED PET SCAN)                                                                                                                                                                                                                                                                            
S8092001003ELECTRON BEAM COMPUTED TOMOGRAPHY (ALSO KNOWN AS ULTRAFAST CT, CINE CT)         Electron beam computed tomog00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S8093001003COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CORONARY ARTERIES, WITH CONTRAST MATERIAL(S)  CT angiography coronary     00      9                                                                                                     I                          Z2  9      02004100120041001        N                           
S8095001003WIG (FOR MEDICALLY-INDUCED OR CONGENITAL HAIR LOSS)                             Wig (for medically-induced h00      9                                                                                                     I                      0088Z2  9      0200001012006010120051231D                           
S8096001003PORTABLE PEAK FLOW METER                                                        Portable peak flow meter    00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S8097001003ASTHMA KIT (INCLUDING BUT NOT LIMITED TO PORTABLE PEAK EXPIRATORY FLOW METER,   Asthma kit                  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8097002004INSTRUCTIONAL VIDEO, BROCHURE, AND/OR SPACER)                                                                                                                                                                                                                                                                        
S8100001003HOLDING CHAMBER OR SPACER FOR USE WITH AN INHALER OR NEBULIZER; WITHOUT MASK    Spacer without mask         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8101001003HOLDING CHAMBER OR SPACER FOR USE WITH AN INHALER OR NEBULIZER; WITH MASK       Spacer with mask            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8105001003OXIMETER FOR MEASURING BLOOD OXYGEN LEVELS NONINVASIVELY                        Oximeter for measuring blood00      9                                                                                                     I                      0088Z2  9      0200101012003010120021231N                           
S8110001003PEAK EXPIRATORY FLOW RATE (PHYSICIAN SERVICES)                                  Peak expiratory flow rate (p00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S8120001003OXYGEN CONTENTS, GASEOUS, 1 UNIT EQUALS 1 CUBIC FOOT                            O2 contents gas cubic ft    00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S8121001003OXYGEN CONTENTS, LIQUID, 1 UNIT EQUALS 1 POUND                                  O2 contents liquid lb       00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S8180001003TRACHEOSTOMY SHOWER PROTECTOR                                                   Trach shower protector      00      9                                                                                                     I                      0088Z2  9      0200201012004010120031231N                           
S8181001003TRACHEOSTOMY TUBE HOLDER                                                        Trach tube holder           00      9                                                                                                     I                      0088Z2  9      0200201012004010120031231N                           
S8182001003HUMIDIFIER, HEATED, USED WITH VENTILATOR, NON-SERVO-CONTROLLED                  Humidifier non-servo        00      9                                                                                                     I                      0088Z2  9      0200201012005010120041231N                           
S8183001003HUMIDIFIER, HEATED, USED WITH VENTILATOR, DUAL SERVO-CONTROLLED WITH            Humidifier dual servo       00      9                                                                                                     I                      0088Z2  9      0200201012005010120041231N                           
S8183002004TEMPERATURE MONITORING                                                                                                                                                                                                                                                                                               
S8185001003FLUTTER DEVICE                                                                  Flutter device              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8186001003SWIVEL ADAPTOR                                                                  Swivel adaptor              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8189001003TRACHEOSTOMY SUPPLY, NOT OTHERWISE CLASSIFIED                                   Trach supply noc            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8190001003ELECTRONIC SPIROMETER (OR MICROSPIROMETER)                                      Electronic spirometer       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8200001003CHEST COMPRESSION VEST                                                          Chest compression vest      00      9                                                                            E0483                    I                      0088Z2  9      0200001012003010120021231N                           
S8205001003CHEST COMPRESSION SYSTEM GENERATOR AND HOSES (FOR USE WITH CHEST  COMPRESSION   Chest compression system gen00      9                                                                            E0483                    I                      0088Z2  9      0200001012003010120021231N                           
S8205002004VEST - S8200)                                                                                                                                                                                                                                                                                                        
S8210001003MUCUS TRAP                                                                      Mucus trap                  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S8260001003ORAL ORTHOTIC FOR TREATMENT OF SLEEP APNEA, INCLUDES FITTING, FABRICATION, AND  Oral orthotic for treatment 00      9                                                                                                     I                      0088Z2  P      02000010120000101        N                           
S8260002004MATERIALS                                                                                                                                                                                                                                                                                                            
S8262001003MANDIBULAR ORTHOPEDIC REPOSITIONING DEVICE, EACH                                Mandib ortho repos device   00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S8265001003HABERMAN FEEDER FOR CLEFT LIP/PALATE                                            Haberman feeder             00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S8270001003ENURESIS ALARM, USING AUDITORY BUZZER AND/OR VIBRATION DEVICE                   Enuresis alarm              00      9                                                                                                     I                          Z2  9      02005070120050701        A                           
S8301001003INFECTION CONTROL SUPPLIES, NOT OTHERWISE SPECIFIED                             Infect control supplies NOS 00      9                                                                                                     I                          Z2  9      02004070120040701        N                           
S8401001003CHILD-SIZE INCONTINENCE GARMENT, DIAPER, EACH                                   Child-size diaper           00      9                                                                            A4529A4530               I                      0088Z2  9      0200201012003010120021231N                           
S8403001003ADULT-SIZED INCONTINENCE GARMENT, DISPOSABLE, PULL-UP BRIEF, EACH               Adult-size pull-up brief    00      9                                                                            A4525A4526A4527A4528     I                      0088Z2  9      0200201012003010120021231N                           
S8404001003CHILD-SIZE INCONTINENCE GARMENT, DISPOSABLE, PULL-UP BRIEF, EACH                Child-size pull-up brief    00      9                                                                            A4531A4532               I                      0088Z2  9      0200201012003010120021231N                           
S8405001003DISPOSABLE LINER/SHIELD FOR INCONTINENCE, EACH                                  Incontinence liners, each   00      9                                                                            A4535                    I                      0088Z2  9      0200101012003010120021231N                           
S8415001003SUPPLIES FOR HOME DELIVERY OF INFANT                                            Supplies for home delivery  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8420001003GRADIENT PRESSURE AID (SLEEVE AND GLOVE COMBINATION), CUSTOM MADE               Custom gradient sleev/glov  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8421001003GRADIENT PRESSURE AID (SLEEVE AND GLOVE COMBINATION), READY MADE                Ready gradient sleev/glov   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8422001003GRADIENT PRESSURE AID (SLEEVE), CUSTOM MADE, MEDIUM WEIGHT                      Custom grad sleeve med      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8423001003GRADIENT PRESSURE AID (SLEEVE), CUSTOM MADE, HEAVY WEIGHT                       Custom grad sleeve heavy    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8424001003GRADIENT PRESSURE AID (SLEEVE), READY MADE                                      Ready gradient sleeve       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8425001003GRADIENT PRESSURE AID (GLOVE), CUSTOM MADE, MEDIUM WEIGHT                       Custom grad glove med       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8426001003GRADIENT PRESSURE AID (GLOVE), CUSTOM MADE, HEAVY WEIGHT                        Custom grad glove heavy     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8427001003GRADIENT PRESSURE AID (GLOVE), READY MADE                                       Ready gradient glove        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8428001003GRADIENT PRESSURE AID (GAUNTLET), READY MADE                                    Ready gradient gauntlet     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8429001003GRADIENT PRESSURE EXTERIOR WRAP                                                 Gradient pressure wrap      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8430001003PADDING FOR COMPRESSION BANDAGE, ROLL                                           Padding for comprssn bdg    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8431001003COMPRESSION BANDAGE, ROLL                                                       Compression bandage         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8433001003SKIN SUPPORT FOR BREAST PROSTHESIS, EACH                                        Skin support/breast prosth  00      9                                                                            A4280                    I                          Z2  9      0200204012003010120021231N                           
S8434001003INTERIM POST-OPERATIVE ORTHOTIC DEVICE FOR UPPER EXTREMITY, CUSTOM MADE         Interim splint upper extrem 00      9                                                                                                     I                          Z2  9      0200504012006010120051231D                           
S8450001003SPLINT, PREFABRICATED, DIGIT (SPECIFY DIGIT BY USE OF MODIFIER)                 Splint digit                00      9                                                                                                     I                      0088Z2  P      02002010120020101        N                           
S8451001003SPLINT, PREFABRICATED, WRIST OR ANKLE                                           Splint wrist or ankle       00      9                                                                                                     I                      0088Z2  P      02002010120020101        N                           
S8452001003SPLINT, PREFABRICATED, ELBOW                                                    Splint elbow                00      9                                                                                                     I                      0088Z2  P      02002010120020101        N                           
S8460001003CAMISOLE, POST-MASTECTOMY                                                       Camisole post-mast          00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S8470001003POSITIONING DEVICE, STANDER, FOR USE BY PATIENT WHO IS UNABLE TO STAND          Stander positioning device  00      9                                                                                                     I                          Z2  9      0200307012004010120031231N                           
S8470002004INDEPENDENTLY (E.G. CEREBRAL PALSY PATIENT)                                                                                                                                                                                                                                                                          
S8490001003INSULIN SYRINGES (100 SYRINGES, ANY SIZE)                                       100 insulin syringes        00      9                                                                                                     I                      0088Z2  S      02002010120020101        N                           
S8940001003EQUESTRIAN/HIPPOTHERAPY, PER SESSION                                            Hippotherapy per session    00      9                                                                                                     I                          Z2  9      02005040120050401        A                           
S8945001003PHYSICAL MEDICINE TREATMENT (CONSTANT ATTENDANCE BY PROVIDER) TO ONE AREA,      PT phonophoresis 30 mins    00      9                                                                                                     I                          Z2  9      0200204012003040120030331N                           
S8945002004INITIAL 30 MINUTES, EACH VISIT; PHONOPHORESIS                                                                                                                                                                                                                                                                        
S8948001003APPLICATION OF A MODALITY (REQUIRING CONSTANT PROVIDER ATTENDANCE) TO ONE OR    Low-level laser trmt 15 min 00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
S8948002004MORE AREAS; LOW-LEVEL LASER; EACH 15 MINUTES                                                                                                                                                                                                                                                                         
S8950001003COMPLEX LYMPHEDEMA THERAPY, EACH 15 MINUTES                                     Complex lymphedema therapy, 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S8990001003PHYSICAL OR MANIPULATIVE THERAPY PERFORMED FOR MAINTENANCE RATHER THAN          Pt or manip for maint       00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S8990002004RESTORATION                                                                                                                                                                                                                                                                                                          
S8999001003RESUSCITATION BAG (FOR USE BY PATIENT ON ARTIFICIAL RESPIRATION DURING POWER    Resuscitation bag           00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S8999002004FAILURE OR OTHER CATASTROPHIC EVENT)                                                                                                                                                                                                                                                                                 
S9001001003HOME UTERINE MONITOR WITH OR WITHOUT ASSOCIATED NURSING SERVICES                Home uterine monitor with or00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9007001003ULTRAFILTRATION MONITOR                                                         Ultrafiltration monitor     00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S9015001003AUTOMATED EEG MONITORING                                                        Automated EEG monitoring    00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S9022001003DIGITAL SUBTRACTION ANGIOGRAPHY (USE IN ADDITION TO CPT CODE FOR THE PROCEDURE  Digital subtraction angiogra00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9022002004FOR FURTHER IDENTIFICATION)                                                                                                                                                                                                                                                                                          
S9024001003PARANASAL SINUS ULTRASOUND                                                      Paranasal sinus ultrasound  00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9025001003OMNICARDIOGRAM/CARDIOINTEGRAM                                                   Omnicardiogram/cardiointegra00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S9034001003EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR GALL STONES (IF PERFORMED WITH ERCP,   ESWL for gallstones         00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9034002004USE 43265)                                                                                                                                                                                                                                                                                                           
S9055001003PROCUREN OR OTHER GROWTH FACTOR PREPARATION TO PROMOTE WOUND HEALING            Procuren or other growth fac00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9056001003COMA STIMULATION PER DIEM                                                       Coma stimulation per diem   00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9061001003HOME ADMINISTRATION OF AEROSOLIZED DRUG THERAPY (E.G., PENTAMIDINE);            Medical supplies and equipme00      9                                                                                                     I                      0088Z2  9      02001010120020101        N                           
S9061002004ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, ALL                                                                                                                                                                                                                                      
S9061003004NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY),                                                                                                                                                                                                                                        
S9061004004PER DIEM                                                                                                                                                                                                                                                                                                             
S9075001003SMOKING CESSATION TREATMENT                                                     Smoking cessation treatment 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9083001003GLOBAL FEE URGENT CARE CENTERS                                                  Urgent care center global   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9088001003SERVICES PROVIDED IN AN URGENT CARE CENTER (LIST IN ADDITION TO CODE FOR        Services provided in urgent 00      9                                                                                                     I                      0088Z2  9      02001010120020101        N                           
S9088002004SERVICE)                                                                                                                                                                                                                                                                                                             
S9090001003VERTEBRAL AXIAL DECOMPRESSION, PER SESSION                                      Vertebral axial decompressio00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9092001003CANOLITH REPOSITIONING, PER VISIT                                               Canolith repositioning      00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9097001003HOME VISIT FOR WOUND CARE                                                       Home visit wound care       00      9                                                                                                     I                          Z2  9      02004100120041001        N                           
S9098001003HOME VISIT, PHOTOTHERAPY SERVICES (E.G. BILI-LITE), INCLUDING EQUIPMENT RENTAL, Home phototherapy visit     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9098002004NURSING SERVICES, BLOOD DRAW, SUPPLIES, AND OTHER SERVICES, PER DIEM                                                                                                                                                                                                                                                 
S9109001003CONGESTIVE HEART FAILURE TELEMONITORING, EQUIPMENT RENTAL, INCLUDING TELESCALE, CHF telemonitoring month    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9109002004COMPUTER SYSTEM AND SOFTWARE, TELEPHONE CONNECTIONS, AND MAINTENANCE, PER MONTH                                                                                                                                                                                                                                      
S9117001003BACK SCHOOL, PER VISIT                                                          Back school visit           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9122001003HOME HEALTH AIDE OR CERTIFIED NURSE ASSISTANT, PROVIDING CARE IN THE HOME; PER  Home health aide or certifie00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9122002004HOUR                                                                                                                                                                                                                                                                                                                 
S9123001003NURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR (USE FOR GENERAL       Nursing care in home RN     00      9                                                                                                     I                      0088Z2  9      02000010120040101        N                           
S9123002004NURSING CARE ONLY, NOT TO BE USED WHEN CPT CODES 99500-99602 CAN BE USED)                                                                                                                                                                                                                                            
S9124001003NURSING CARE, IN THE HOME; BY LICENSED PRACTICAL NURSE, PER HOUR                Nursing care, in the home; b00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9125001003RESPITE CARE, IN THE HOME, PER DIEM                                             Respite care, in the home, p00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9126001003HOSPICE CARE, IN THE HOME, PER DIEM                                             Hospice care, in the home, p00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9127001003SOCIAL WORK VISIT, IN THE HOME, PER DIEM                                        Social work visit, in the ho00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9128001003SPEECH THERAPY, IN THE HOME, PER DIEM                                           Speech therapy, in the home,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9129001003OCCUPATIONAL THERAPY, IN THE HOME, PER DIEM                                     Occupational therapy, in the00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9131001003PHYSICAL THERAPY; IN THE HOME, PER DIEM                                         PT in the home per diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9140001003DIABETIC MANAGEMENT PROGRAM, FOLLOW-UP VISIT TO NON-MD PROVIDER                 Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9141001003DIABETIC MANAGEMENT PROGRAM, FOLLOW-UP VISIT TO MD PROVIDER                     Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9145001003INSULIN PUMP INITIATION, INSTRUCTION IN INITIAL USE OF PUMP (PUMP NOT INCLUDED) Insulin pump initiation     00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9150001003EVALUATION BY OCULARIST                                                         Evaluation by ocularist     00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9208001003HOME MANAGEMENT OF PRETERM LABOR, INCLUDING ADMINISTRATIVE SERVICES,            Home mgmt preterm labor     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9208002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9208003004OR EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT USE                                                                                                                                                                                                                                       
S9208004004THIS CODE WITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                      
S9209001003HOME MANAGEMENT OF PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM), INCLUDING    Home mgmt PPROM             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9209002004ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S9209003004ALL NECESSARY SUPPLIES OR EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                  
S9209004004SEPARATELY), PER DIEM (DO NOT USE THIS CODE WITH ANY HOME INFUSION PER DIEM                                                                                                                                                                                                                                          
S9209005004CODE)                                                                                                                                                                                                                                                                                                                
S9211001003HOME MANAGEMENT OF GESTATIONAL HYPERTENSION, INCLUDES ADMINISTRATIVE SERVICES,  Home mgmt gest hypertension 00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9211002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                         
S9211003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY); PER DIEM (DO NOT USE                                                                                                                                                                                                                                      
S9211004004THIS CODE WITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                      
S9212001003HOME MANAGEMENT OF POSTPARTUM HYPERTENSION, INCLUDES ADMINISTRATIVE SERVICES,   Hm postpar hyper per diem   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9212002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9212003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT USE                                                                                                                                                                                                                                      
S9212004004THIS CODE WITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                      
S9213001003HOME MANAGEMENT OF PREECLAMPSIA, INCLUDES ADMINISTRATIVE SERVICES, PROFESSIONAL Hm preeclamp per diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9213002004PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S9213003004(DRUGS AND NURSING SERVICES CODED SEPARATELY); PER DIEM (DO NOT USE THIS CODE                                                                                                                                                                                                                                        
S9213004004WITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                                
S9214001003HOME MANAGEMENT OF GESTATIONAL DIABETES, INCLUDES ADMINISTRATIVE SERVICES,      Hm gest dm per diem         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9214002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9214003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY); PER DIEM (DO NOT USE                                                                                                                                                                                                                                      
S9214004004THIS CODE WITH ANY HOME INFUSION PER DIEM CODE)                                                                                                                                                                                                                                                                      
S9216001003NURSING SERVICES AND ALL NECESSARY EQUIPMENT AND SUPPLIES FOR GESTATIONAL       Gest hyper w nurs diem      00      9                                                                            S9211                    I                      0088Z2  9      0200201012003010120021231N                           
S9216002004HYPERTENSION PROGRAM (INCLUDES MATERNAL ASSESSMENT AS NEEDED, TELEPHONIC                                                                                                                                                                                                                                             
S9216003004COLLECTION OF BLOOD PRESSURE, URINE PROTEIN, WEIGHT AND FETAL MOVEMENT COUNTING                                                                                                                                                                                                                                      
S9216004004VIA A HOME DATA COLLECTION SYSTEM, PATIENT STATUS REPORTS, 24 HOUR/7 DAY A WEEK                                                                                                                                                                                                                                      
S9216005004NURSING SUPPORT, AND ALL EDUCATION TO THE PATIENT AND CAREGIVER); PER DIEM                                                                                                                                                                                                                                           
S9217001003NURSING SERVICES AND ALL NECESSARY EQUIPMENT AND SUPPLIES FOR POSTPARTUM        Postpar hyper w nurs diem   00      9                                                                            S9212                    I                      0088Z2  9      0200201012003010120021231N                           
S9217002004HYPERTENSION PROGRAM (INCLUDES MATERNAL ASSESSMENT AS NEEDED, TELEPHONIC                                                                                                                                                                                                                                             
S9217003004COLLECTION OF BLOOD PRESSURE, URINE PROTEIN, WEIGHT, COMPLIANCE MANAGEMENT                                                                                                                                                                                                                                           
S9217004004SUPPORT, PATIENT STATUS REPORTS, 24 HOUR/7 DAY A WEEK NURSING SUPPORT, AND ALL                                                                                                                                                                                                                                       
S9217005004EDUCATION TO THE PATIENT AND CAREGIVER); PER DIEM                                                                                                                                                                                                                                                                    
S9218001003NURSING SERVICES AND ALL NECESSARY EQUIPMENT AND SUPPLIES FOR PREECLAMPSIA      Preeclamp w nurs diem       00      9                                                                            S9213                    I                      0088Z2  9      0200201012003010120021231N                           
S9218002004PROGRAM (INCLUDES MATERNAL ASSESSMENT AS NEEDED, TELEPHONIC COLLECTION OF BLOOD                                                                                                                                                                                                                                      
S9218003004PRESSURE, URINE PROTEIN, WEIGHT AND DAILY FETAL MOVEMENT COUNTS VIA A HOME DATA                                                                                                                                                                                                                                      
S9218004004COLLECTION SYSTEM, COMPLIANCE MANAGEMENT SUPPORT, PATIENT STATUS REPORTS, 24                                                                                                                                                                                                                                         
S9218005004HOUR/7 DAY A WEEK NURSING SUPPORT, AND ALL EDUCATION TO THE PATIENT AND                                                                                                                                                                                                                                              
S9218006004CAREGIVER); PER DIEM                                                                                                                                                                                                                                                                                                 
S9325001003HOME INFUSION THERAPY, PAIN MANAGEMENT INFUSION; ADMINISTRATIVE SERVICES,       HIT pain mgmt per diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9325002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9325003004AND EQUIPMENT, (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT                                                                                                                                                                                                                                         
S9325004004USE THIS CODE WITH S9326, S9327 OR S9328)                                                                                                                                                                                                                                                                            
S9326001003HOME INFUSION THERAPY, CONTINUOUS (TWENTY-FOUR HOURS OR MORE) PAIN MANAGEMENT   HIT cont pain per diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9326002004INFUSION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S9326003004COORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS                                                                                                                                                                                                                                      
S9326004004CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                          
S9327001003HOME INFUSION THERAPY, INTERMITTENT (LESS THAN TWENTY-FOUR HOURS) PAIN          HIT int pain per diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9327002004MANAGEMENT INFUSION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES,                                                                                                                                                                                                                                        
S9327003004CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                       
S9327004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9328001003HOME INFUSION THERAPY, IMPLANTED PUMP PAIN MANAGEMENT INFUSION; ADMINISTRATIVE  HIT pain imp pump diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9328002004SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S9328003004SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S9329001003HOME INFUSION THERAPY, CHEMOTHERAPY INFUSION; ADMINISTRATIVE SERVICES,          HIT chemo per diem          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9329002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9329003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT USE                                                                                                                                                                                                                                      
S9329004004THIS CODE WITH S9330 OR S9331)                                                                                                                                                                                                                                                                                       
S9330001003HOME INFUSION THERAPY, CONTINUOUS (TWENTY-FOUR HOURS OR MORE) CHEMOTHERAPY      HIT cont chem diem          00      9                                                                                                     I                          Z2  9      02002010120020101        N                           
S9330002004INFUSION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S9330003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9330004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9331001003HOME INFUSION THERAPY, INTERMITTENT (LESS THAN TWENTY-FOUR HOURS) CHEMOTHERAPY  HIT intermit chemo diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9331002004INFUSION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S9331003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9331004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9335001003HOME THERAPY, HEMODIALYSIS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY      HT hemodialysis diem        00      9                                                                                                     I                          Z2  9      02003070120030701        N                           
S9335002004SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS                                                                                                                                                                                                                                         
S9335003004AND NURSING SERVICES CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                     
S9336001003HOME INFUSION THERAPY, CONTINUOUS ANTICOAGULANT INFUSION THERAPY (E.G.          HIT cont anticoag diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9336002004HEPARIN), ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S9336003004COORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS                                                                                                                                                                                                                                      
S9336004004CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                          
S9338001003HOME INFUSION THERAPY, IMMUNOTHERAPY, ADMINISTRATIVE SERVICES, PROFESSIONAL     HIT immunotherapy diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9338002004PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S9338003004(DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                
S9339001003HOME THERAPY; PERITONEAL DIALYSIS, ADMINISTRATIVE SERVICES, PROFESSIONAL        HIT periton dialysis diem   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9339002004PHARMACY SERVICES, CARE COORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                        
S9339003004(DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                
S9340001003HOME THERAPY; ENTERAL NUTRITION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY HIT enteral per diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9340002004SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (ENTERAL                                                                                                                                                                                                                                       
S9340003004FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                               
S9341001003HOME THERAPY; ENTERAL NUTRITION VIA GRAVITY; ADMINISTRATIVE SERVICES,           HIT enteral grav diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9341002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9341003004AND EQUIPMENT (ENTERAL FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                        
S9342001003HOME THERAPY; ENTERAL NUTRITION VIA PUMP; ADMINISTRATIVE SERVICES, PROFESSIONAL HIT enteral pump diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9342002004PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S9342003004(ENTERAL FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                      
S9343001003HOME THERAPY; ENTERAL NUTRITION VIA BOLUS; ADMINISTRATIVE SERVICES,             HIT enteral bolus nurs      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9343002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9343003004AND EQUIPMENT (ENTERAL FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                        
S9345001003HOME INFUSION THERAPY, ANTI-HEMOPHILIC AGENT INFUSION THERAPY (E.G. FACTOR      HIT anti-hemophil diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9345002004VIII); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                                 
S9345003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9345004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9346001003HOME INFUSION THERAPY, ALPHA-1-PROTEINASE INHIBITOR (E.G., PROLASTIN);          HIT alpha-1-proteinas diem  00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9346002004ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S9346003004ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                 
S9346004004SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                                
S9347001003HOME INFUSION THERAPY, UNINTERRUPTED, LONG-TERM, CONTROLLED RATE INTRAVENOUS OR HIT longterm infusion diem  00      9                                                                                                     I                      0088Z2  9      02002010120030101        N                           
S9347002004SUBCUTANEOUS INFUSION THERAPY (E.G. EPOPROSTENOL); ADMINISTRATIVE SERVICES,                                                                                                                                                                                                                                          
S9347003004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9347004004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S9348001003HOME INFUSION THERAPY, SYMPATHOMIMETIC/INOTROPIC AGENT INFUSION THERAPY (E.G.,  HIT sympathomim diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9348002004DOBUTAMINE); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                           
S9348003004COORDINATION, ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS                                                                                                                                                                                                                                         
S9348004004CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                          
S9349001003HOME INFUSION THERAPY, TOCOLYTIC INFUSION THERAPY; ADMINISTRATIVE SERVICES,     HIT tocolysis diem          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9349002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9349003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S9351001003HOME INFUSION THERAPY, CONTINUOUS ANTI-EMETIC INFUSION THERAPY; ADMINISTRATIVE  HIT cont antiemetic diem    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9351002004SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, ALL NECESSARY                                                                                                                                                                                                                                           
S9351003004SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S9353001003HOME INFUSION THERAPY, CONTINUOUS INSULIN INFUSION THERAPY; ADMINISTRATIVE      HIT cont insulin diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9353002004SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S9353003004SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S9355001003HOME INFUSION THERAPY, CHELATION THERAPY; ADMINISTRATIVE SERVICES, PROFESSIONAL HIT chelation diem          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9355002004PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S9355003004(DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                
S9357001003HOME INFUSION THERAPY, ENZYME REPLACEMENT INTRAVENOUS THERAPY; (E.G.            HIT enzyme replace diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9357002004IMIGLUCERASE); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                         
S9357003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9357004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9359001003HOME INFUSION THERAPY, ANTI-TUMOR NECROSIS FACTOR INTRAVENOUS THERAPY; (E.G.    HIT anti-tnf per diem       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9359002004INFLIXIMAB); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                           
S9359003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9359004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9361001003HOME INFUSION THERAPY, DIURETIC INTRAVENOUS THERAPY; ADMINISTRATIVE SERVICES,   HIT diuretic infus diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9361002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9361003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S9363001003HOME INFUSION THERAPY, ANTI-SPASMOTIC THERAPY; ADMINISTRATIVE SERVICES,         HIT anti-spasmotic diem     00      9                                                                                                     I                      0088Z2  9      02002010120041001        N                           
S9363002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9363003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S9364001003HOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); ADMINISTRATIVE         HIT tpn total diem          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9364002004SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S9364003004SUPPLIES AND EQUIPMENT INCLUDING STANDARD TPN FORMULA (LIPIDS, SPECIALTY AMINO                                                                                                                                                                                                                                       
S9364004004ACID FORMULAS, DRUGS OTHER THAN IN STANDARD FORMULA AND NURSING VISITS CODED                                                                                                                                                                                                                                         
S9364005004SEPARATELY), PER DIEM (DO NOT USE WITH HOME INFUSION CODES S9365-S9368 USING                                                                                                                                                                                                                                         
S9364006004DAILY VOLUME SCALES)                                                                                                                                                                                                                                                                                                 
S9365001003HOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); ONE LITER PER DAY,     HIT tpn 1 liter diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9365002004ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S9365003004ALL NECESSARY SUPPLIES AND EQUIPMENT INCLUDING STANDARD TPN FORMULA (LIPIDS,                                                                                                                                                                                                                                         
S9365004004SPECIALTY AMINO ACID FORMULAS, DRUGS OTHER THAN IN STANDARD FORMULA AND NURSING                                                                                                                                                                                                                                      
S9365005004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9366001003HOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); MORE THAN ONE LITER    HIT tpn 2 liter diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9366002004BUT NO MORE THAN TWO LITERS PER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL                                                                                                                                                                                                                                           
S9366003004PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S9366004004INCLUDING STANDARD TPN FORMULA (LIPIDS, SPECIALTY AMINO ACID FORMULAS, DRUGS                                                                                                                                                                                                                                         
S9366005004OTHER THAN IN STANDARD FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                        
S9367001003HOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); MORE THAN TWO LITERS   HIT tpn 3 liter diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9367002004BUT NO MORE THAN THREE LITERS PER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL                                                                                                                                                                                                                                         
S9367003004PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S9367004004INCLUDING STANDARD TPN FORMULA (LIPIDS, SPECIALTY AMINO ACID FORMULAS, DRUGS                                                                                                                                                                                                                                         
S9367005004OTHER THAN IN STANDARD FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                        
S9368001003HOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); MORE THAN THREE LITERS HIT tpn over 3l diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9368002004PER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S9368003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT INCLUDING STANDARD TPN                                                                                                                                                                                                                                        
S9368004004FORMULA (LIPIDS, SPECIALTY AMINO ACID FORMULAS, DRUGS OTHER THAN IN STANDARD                                                                                                                                                                                                                                         
S9368005004FORMULA AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                               
S9370001003HOME THERAPY, INTERMITTENT ANTI-EMETIC INJECTION THERAPY; ADMINISTRATIVE        HT inj antiemetic diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9370002004SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S9370003004SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S9372001003HOME THERAPY; INTERMITTENT ANTICOAGULANT INJECTION THERAPY (E.G. HEPARIN);      HT inj anticoag diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9372002004ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S9372003004ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                 
S9372004004SEPARATELY), PER DIEM (DO NOT USE THIS CODE FOR FLUSHING OF INFUSION DEVICES                                                                                                                                                                                                                                         
S9372005004WITH HEPARIN TO MAINTAIN PATENCY)                                                                                                                                                                                                                                                                                    
S9373001003HOME INFUSION THERAPY, HYDRATION THERAPY; ADMINISTRATIVE SERVICES, PROFESSIONAL HIT hydra total diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9373002004PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                       
S9373003004(DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM (DO NOT USE WITH                                                                                                                                                                                                                                               
S9373004004HYDRATION THERAPY CODES S9374-S9377 USING DAILY VOLUME SCALES)                                                                                                                                                                                                                                                       
S9374001003HOME INFUSION THERAPY, HYDRATION THERAPY; ONE LITER PER DAY, ADMINISTRATIVE     HIT hydra 1 liter diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9374002004SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S9374003004SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S9375001003HOME INFUSION THERAPY, HYDRATION THERAPY; MORE THAN ONE LITER BUT NO MORE THAN  HIT hydra 2 liter diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9375002004TWO LITERS PER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES,                                                                                                                                                                                                                                         
S9375003004CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                       
S9375004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9376001003HOME INFUSION THERAPY, HYDRATION THERAPY; MORE THAN TWO LITERS BUT NO MORE THAN HIT hydra 3 liter diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9376002004THREE LITERS PER DAY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES,                                                                                                                                                                                                                                       
S9376003004CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                       
S9376004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9377001003HOME INFUSION THERAPY, HYDRATION THERAPY; MORE THAN THREE LITERS PER DAY,       HIT hydra over 3l diem      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9377002004ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S9377003004ALL NECESSARY SUPPLIES (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S9379001003HOME INFUSION THERAPY, INFUSION THERAPY, NOT OTHERWISE CLASSIFIED;              HIT noc per diem            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9379002004ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S9379003004ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                 
S9379004004SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                                
S9381001003DELIVERY OR SERVICE TO HIGH RISK AREAS REQUIRING ESCORT OR EXTRA PROTECTION,    HIT high risk/escort        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9381002004PER VISIT                                                                                                                                                                                                                                                                                                            
S9401001003ANTICOAGULATION CLINIC, INCLUSIVE OF ALL SERVICES EXCEPT LABORATORY TESTS, PER  Anticoag clinic per session 00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9401002004SESSION                                                                                                                                                                                                                                                                                                              
S9430001003PHARMACY COMPOUNDING AND DISPENSING SERVICES                                    Pharmacy comp/disp serv     00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9434001003MODIFIED SOLID FOOD SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM                 Mod solid food suppl        00      9                                                                                                     I                          Z2  9      02003040120030401        N                           
S9435001003MEDICAL FOODS FOR INBORN ERRORS OF METABOLISM                                   Medical foods for inborn err00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S9436001003CHILDBIRTH PREPARATION/LAMAZE CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION      Lamaze class                00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9437001003CHILDBIRTH REFRESHER CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION               Childbirth refresher class  00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9438001003CESAREAN BIRTH CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                     Cesarean birth class        00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9439001003VBAC (VAGINAL BIRTH AFTER CESAREAN) CLASSES, NON-PHYSICIAN PROVIDER, PER SESSIONVBAC class                  00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9441001003ASTHMA EDUCATION, NON-PHYSICIAN PROVIDER, PER SESSION                           Asthma education            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9442001003BIRTHING CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                           Birthing class              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9443001003LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                          Lactation class             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9444001003PARENTING CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                          Parenting class             00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9445001003PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER,            PT education noc individ    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9445002004INDIVIDUAL, PER SESSION                                                                                                                                                                                                                                                                                              
S9446001003PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, GROUP, PER PT education noc group      00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9446002004SESSION                                                                                                                                                                                                                                                                                                              
S9447001003INFANT SAFETY (INCLUDING CPR) CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION      Infant safety class         00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9449001003WEIGHT MANAGEMENT CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                  Weight mgmt class           00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9451001003EXERCISE CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                           Exercise class              00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9452001003NUTRITION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                          Nutrition class             00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9453001003SMOKING CESSATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                  Smoking cessation class     00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9454001003STRESS MANAGEMENT CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION                  Stress mgmt class           00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9455001003DIABETIC MANAGEMENT PROGRAM, GROUP SESSION                                      Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9460001003DIABETIC MANAGEMENT PROGRAM, NURSE VISIT                                        Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9465001003DIABETIC MANAGEMENT PROGRAM, DIETITIAN VISIT                                    Diabetic Management Program,00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9470001003NUTRITIONAL COUNSELING, DIETITIAN VISIT                                         Nutritional counseling, diet00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9472001003CARDIAC REHABILITATION PROGRAM, NON-PHYSICIAN PROVIDER, PER DIEM                Cardiac rehabilitation progr00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9473001003PULMONARY REHABILITATION PROGRAM, NON-PHYSICIAN PROVIDER, PER DIEM              Pulmonary rehabilitation pro00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9474001003ENTEROSTOMAL THERAPY BY A REGISTERED NURSE CERTIFIED IN ENTEROSTOMAL THERAPY,   Enterostomal therapy by a re00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9474002004PER DIEM                                                                                                                                                                                                                                                                                                             
S9475001003AMBULATORY SETTING SUBSTANCE ABUSE TREATMENT OR DETOXIFICATION SERVICES, PER    Ambulatory setting substance00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9475002004DIEM                                                                                                                                                                                                                                                                                                                 
S9476001003VESTIBULAR REHABILITATION PROGRAM, NON-PHYSICIAN PROVIDER, PER DIEM             Vestibular rehab per diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
S9480001003INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM                             Intensive outpatient psychia00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9482001003FAMILY STABILIZATION SERVICES, PER 15 MINUTES                                   Family stabilization 15 min 00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
S9484001003CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER HOUR                            Crisis intervention per hour00      9                                                                                                     I                          Z2  9      02002070120020701        N                           
S9485001003CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM                            Crisis intervention mental h00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9490001003HOME INFUSION THERAPY, CORTICOSTEROID INFUSION; ADMINISTRATIVE SERVICES,        HIT corticosteroid/diem     00      9                                                                                                     I                          Z2  9      02002070120020701        N                           
S9490002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9490003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S9494001003HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY;            HIT antibiotic total diem   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9494002004ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND                                                                                                                                                                                                                                      
S9494003004ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED                                                                                                                                                                                                                                                 
S9494004004SEPARATELY, PER DIEM) (DO NOT USE THIS CODE WITH HOME INFUSION CODES FOR HOURLY                                                                                                                                                                                                                                      
S9494005004DOSING SCHEDULES S9497-S9504)                                                                                                                                                                                                                                                                                        
S9497001003HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY HIT antibiotic q3h diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S94970020043 HOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S9497003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9497004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9500001003HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY HIT antibiotic q24h diem    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S950000200424 HOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S9500003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9500004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9501001003HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY HIT antibiotic q12h diem    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S950100200412 HOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S9501003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9501004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9502001003HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY HIT antibiotic q8h diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S95020020048 HOURS, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                               
S9502003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9502004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9503001003HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL; ONCE EVERY 6       HIT antibiotic q6h diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9503002004HOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                                 
S9503003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9503004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9504001003HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL; ONCE EVERY 4       HIT antibiotic q4h diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9504002004HOURS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                                 
S9504003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9504004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9524001003NURSING SERVICES RELATED TO HOME IV THERAPY, PER DIEM                           Nursing services related to 00      9                                                                                                     I                      0088Z2  9      0200001012003040120030331N                           
S9529001003ROUTINE VENIPUNCTURE FOR COLLECTION OF SPECIMEN(S), SINGLE HOME BOUND, NURSING  Venipuncture home/snf       00      9                                                                                                     I                      0088Z2  5      02002010120020101        N                           
S9529002004HOME, OR SKILLED NURSING FACILITY PATIENT                                                                                                                                                                                                                                                                            
S9537001003HOME THERAPY; HEMATOPOIETIC HORMONE INJECTION THERAPY (E.G.ERYTHROPOIETIN,      HT hem horm inj diem        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9537002004G-CSF, GM-CSF); ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                        
S9537003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9537004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9538001003HOME TRANSFUSION OF BLOOD PRODUCT(S); ADMINISTRATIVE SERVICES, PROFESSIONAL     HIT blood products diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9538002004PHARMACY SERVICES, CARE COORDINATION AND ALL NECESSARY SUPPLIES AND EQUIPMENT                                                                                                                                                                                                                                        
S9538003004(BLOOD PRODUCTS, DRUGS, AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                               
S9542001003HOME INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED, INCLUDING ADMINISTRATIVE     HT inj noc per diem         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9542002004SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY                                                                                                                                                                                                                                       
S9542003004SUPPLIES AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                         
S9543001003ADMINISTRATION OF MEDICATION, INTRAMUSCULARLY, EPIDURALLY OR SUBCUTANEOUSLY, IN Administration of medication00      9                                                                                                     I                      0088Z2  9      0200001012002040120020331N                           
S9543002004THE HOME SETTING, INCLUDING ALL NURSING CARE, EQUIPMENT, AND SUPPLIES; PER DIEM                                                                                                                                                                                                                                      
S9546001003HOME INFUSION OF BLOOD PRODUCTS, NURSING SERVICES, PER VISIT                    Home inf blood prod nurs ser00      9                                                                                                     I                          Z2  9      0200204012003100120030930N                           
S9558001003HOME INJECTABLE THERAPY; GROWTH HORMONE, INCLUDING ADMINISTRATIVE SERVICES,     HT inj growth horm diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9558002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9558003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S9559001003HOME INJECTABLE THERAPY, INTERFERON, INCLUDING ADMINISTRATIVE SERVICES,         HIT inj interferon diem     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9559002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9559003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S9560001003HOME INJECTABLE THERAPY; HORMONAL THERAPY (E.G.; LEUPROLIDE, GOSERELIN),        HT inj hormone diem         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9560002004INCLUDING ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE                                                                                                                                                                                                                                              
S9560003004COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS AND NURSING                                                                                                                                                                                                                                            
S9560004004VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                                   
S9562001003HOME INJECTABLE THERAPY, PALIVIZUMAB, INCLUDING ADMINISTRATIVE SERVICES,        HT inj palivizumab diem     00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S9562002004PROFESSIONAL PHARMACY SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES                                                                                                                                                                                                                                        
S9562003004AND EQUIPMENT (DRUGS AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                  
S9590001003HOME THERAPY, IRRIGATION THERAPY (E.G. STERILE IRRIGATION OF AN ORGAN OR        HT irrigation diem          00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
S9590002004ANATOMICAL CAVITY); INCLUDING ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY                                                                                                                                                                                                                                         
S9590003004SERVICES, CARE COORDINATION, AND ALL NECESSARY SUPPLIES AND EQUIPMENT (DRUGS                                                                                                                                                                                                                                         
S9590004004AND NURSING VISITS CODED SEPARATELY), PER DIEM                                                                                                                                                                                                                                                                       
S9800001003HOME THERAPY; PROVISION OF INFUSION, SPECIALTY DRUG ADMINISTRATION, AND/OR      HT rn per hour              00      9                                                                            S9802S9803               I                      0088Z2  1      0200201012003010120021231N                           
S9800002004ASSOCIATED NURSING SERVICES AND PROCEDURES, BY HIGHLY TECHNICAL R.N., PER HOUR                                                                                                                                                                                                                                       
S9800003004(DO NOT USE THIS CODE WITH S9524)                                                                                                                                                                                                                                                                                    
S9802001003HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, NURSING SERVICES; PER VISIT (UP TO HT nursing visit            00      9                                                                                                     I                          Z2  9      0200301012003070120030630N                           
S98020020042 HOURS)                                                                                                                                                                                                                                                                                                             
S9803001003HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, NURSING SERVICES; EACH ADDITIONAL  HT nursing addl hr          00      9                                                                                                     I                          Z2  9      0200301012003070120030630N                           
S9803002004HOUR (LIST SEPARATELY IN ADDITION TO CODE S9802)                                                                                                                                                                                                                                                                     
S9806001003RN SERVICES IN THE INFUSION SUITE OF THE IV THERAPY PROVIDER, PER VISIT         RN infusion suite visit     00      9                                                                                                     I                          Z2  9      0200207012004010120031231N                           
S9810001003HOME THERAPY; PROFESSIONAL PHARMACY SERVICES FOR PROVISION OF INFUSION,         HT pharm per hour           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9810002004SPECIALTY DRUG ADMINISTRATION, AND/OR DISEASE STATE MANAGEMENT, NOT OTHERWISE                                                                                                                                                                                                                                        
S9810003004CLASSIFIED, PER HOUR (DO NOT USE THIS CODE WITH ANY PER DIEM CODE)                                                                                                                                                                                                                                                   
S9900001003SERVICES BY AUTHORIZED CHRISTIAN SCIENCE PRACTITIONER FOR THE PROCESS OF        Christian Sci Pract visit   00      9                                                                                                     I                          Z2  9      02002070120020701        N                           
S9900002004HEALING, PER DIEM; NOT TO BE USED FOR REST OR STUDY; EXCLUDES IN-PATIENT                                                                                                                                                                                                                                             
S9900003004SERVICES                                                                                                                                                                                                                                                                                                             
S9970001003HEALTH CLUB MEMBERSHIP, ANNUAL                                                  Health club membership yr   00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9975001003TRANSPLANT RELATED LODGING, MEALS AND TRANSPORTATION, PER DIEM                  Transplant related per diem 00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S9976001003LODGING, PER DIEM, NOT OTHERWISE CLASSIFIED                                     Lodging per diem            00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S9977001003MEALS, PER DIEM, NOT OTHERWISE SPECIFIED                                        Meals per diem              00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S9981001003MEDICAL RECORDS COPYING FEE, ADMINISTRATIVE                                     Med record copy admin       00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9982001003MEDICAL RECORDS COPYING FEE, PER PAGE                                           Med record copy per page    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9986001003NOT MEDICALLY NECESSARY SERVICE (PATIENT IS AWARE THAT SERVICE NOT MEDICALLY    Not medically necessary svc 00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9986002004NECESSARY)                                                                                                                                                                                                                                                                                                           
S9988001003SERVICES PROVIDED AS PART OF A PHASE I CLINICAL TRIAL                           Serv part of phase I trial  00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S9989001003SERVICES PROVIDED OUTSIDE OF THE UNITED STATES OF AMERICA (LIST IN ADDITION TO  Services outside US         00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9989002004CODE(S) FOR SERVICES(S))                                                                                                                                                                                                                                                                                             
S9990001003SERVICES PROVIDED AS PART OF A PHASE II CLINICAL TRIAL                          Services provided as part of00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9991001003SERVICES PROVIDED AS PART OF A PHASE III CLINICAL TRIAL                         Services provided as part of00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9992001003TRANSPORTATION COSTS TO AND FROM TRIAL LOCATION AND LOCAL TRANSPORTATION COSTS  Transportation costs to and 00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9992002004(E.G., FARES FOR TAXICAB OR BUS) FOR CLINICAL TRIAL PARTICIPANT AND ONE                                                                                                                                                                                                                                              
S9992003004CAREGIVER/COMPANION                                                                                                                                                                                                                                                                                                  
S9994001003LODGING COSTS (E.G., HOTEL CHARGES) FOR CLINICAL TRIAL PARTICIPANT AND ONE      Lodging costs (e.g. hotel ch00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9994002004CAREGIVER/COMPANION                                                                                                                                                                                                                                                                                                  
S9996001003MEALS FOR CLINICAL TRIAL PARTICIPANT AND ONE CAREGIVER/COMPANION                Meals for clinical trial par00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S9999001003SALES TAX                                                                       Sales tax                   00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
T1000001003PRIVATE DUTY / INDEPENDENT NURSING SERVICE(S) - LICENSED, UP TO 15 MINUTES      Private duty/independent nsg00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1001001003NURSING ASSESSMENT / EVALUATION                                                 Nursing assessment/evaluatn 00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1002001003RN SERVICES, UP TO 15 MINUTES                                                   RN services up to 15 minutes00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1003001003LPN/LVN SERVICES, UP TO 15 MINUTES                                              LPN/LVN services up to 15min00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1004001003SERVICES OF A QUALIFIED NURSING AIDE, UP TO 15 MINUTES                          Nsg aide service up to 15min00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1005001003RESPITE CARE SERVICES, UP TO 15 MINUTES                                         Respite care service 15 min 00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1006001003ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, FAMILY/COUPLE COUNSELING               Family/Couple Counseling    00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1007001003ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, TREATMENT PLAN DEVELOPMENT AND/OR      Treatment Plan Development  00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1007002004MODIFICATION                                                                                                                                                                                                                                                                                                         
T1008001003DAY TREATMENT FOR  INDIVIDUAL ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES           Day Treatment for Individual00      9                                                                                                     I                          Z2  9      0200107012003040120030331N                           
T1009001003CHILD SITTING SERVICES FOR CHILDREN OF THE INDIVIDUAL RECEIVING ALCOHOL AND/OR  Child Sitting Services      00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1009002004SUBSTANCE ABUSE SERVICES                                                                                                                                                                                                                                                                                             
T1010001003MEALS FOR INDIVIDUALS RECEIVING ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES (WHEN   Meals when Receive Services 00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1010002004MEALS NOT INCLUDED IN THE PROGRAM)                                                                                                                                                                                                                                                                                   
T1011001003ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, NOT OTHERWISE CLASSIFIED               Alcohol/Substance Abuse NOC 00      9                                                                                                     I                          Z2  9      0200107012003040120030331N                           
T1012001003ALCOHOL AND/OR SUBSTANCE ABUSE SERVICES, SKILLS DEVELOPMENT                     Alcohol/Substance Abuse Skil00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1013001003SIGN LANGUAGE OR ORAL INTERPRETIVE SERVICES, PER 15 MINUTES                     Sign Lang/Oral Interpreter  00      9                                                                                                     I                          Z2  9      02001070120030101        N                           
T1014001003TELEHEALTH TRANSMISSION, PER MINUTE, PROFESSIONAL SERVICES BILL SEPARATELY      Telehealth transmit, per min00      9                                                                                                     I                          Z2  9      02001070120010701        N                           
T1015001003CLINIC VISIT/ENCOUNTER, ALL-INCLUSIVE                                           Clinic service              00      9                                                                                                     I                          Z2  1      02002010120020101        N                           
T1016001003CASE MANAGEMENT, EACH 15 MINUTES                                                Case management             00      9                                                                                                     I                          Z2  9      02002070120020701        N                           
T1017001003TARGETED CASE MANAGEMENT, EACH 15 MINUTES                                       Targeted case management    00      9                                                                                                     I                          Z2  9      02002070120020701        N                           
T1018001003SCHOOL-BASED INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES, BUNDLED           School-based IEP ser bundled00      9                                                                                                     I                          Z2  9      02002070120020701        N                           
T1019001003PERSONAL CARE SERVICES, PER 15 MINUTES, NOT FOR AN INPATIENT OR RESIDENT OF A   Personal care ser per 15 min00      9                                                                                                     I                          Z2  9      02002070120020701        N                           
T1019002004HOSPITAL, NURSING FACILITY, ICF/MR OR IMD, PART OF THE INDIVIDUALIZED PLAN OF                                                                                                                                                                                                                                        
T1019003004TREATMENT (CODE MAY NOT BE USED TO IDENTIFY SERVICES PROVIDED BY HOME HEALTH                                                                                                                                                                                                                                         
T1019004004AIDE OR CERTIFIED NURSE ASSISTANT)                                                                                                                                                                                                                                                                                   
T1020001003PERSONAL CARE SERVICES, PER DIEM, NOT FOR AN INPATIENT OR RESIDENT OF A         Personal care ser per diem  00      9                                                                                                     I                          Z2  9      02002070120020701        N                           
T1020002004HOSPITAL, NURSING FACILITY, ICF/MR OR IMD, PART OF THE INDIVIDUALIZED PLAN OF                                                                                                                                                                                                                                        
T1020003004TREATMENT (CODE MAY NOT BE USED TO IDENTIFY SERVICES PROVIDED BY HOME HEALTH                                                                                                                                                                                                                                         
T1020004004AIDE OR CERTIFIED NURSE ASSISTANT)                                                                                                                                                                                                                                                                                   
T1021001003HOME HEALTH AIDE OR CERTIFIED NURSE ASSISTANT, PER VISIT                        HH Aide or cn aide per visit00      9                                                                                                     I                          Z2  9      02002070120020701        N                           
T1022001003CONTRACTED HOME HEALTH AGENCY SERVICES, ALL SERVICES PROVIDED UNDER CONTRACT,   Contracted services per day 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1022002004PER DAY                                                                                                                                                                                                                                                                                                              
T1023001003SCREENING TO DETERMINE THE APPROPRIATENESS OF CONSIDERATION OF AN INDIVIDUAL    Program intake assessment   00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1023002004FOR PARTICIPATION IN A SPECIFIED PROGRAM, PROJECT OR TREATMENT PROTOCOL, PER                                                                                                                                                                                                                                         
T1023003004ENCOUNTER                                                                                                                                                                                                                                                                                                            
T1024001003EVALUATION AND TREATMENT BY AN INTEGRATED, SPECIALTY TEAM CONTRACTED TO PROVIDE Team evaluation & management00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1024002004COORDINATED CARE TO MULTIPLE OR SEVERELY HANDICAPPED CHILDREN, PER ENCOUNTER                                                                                                                                                                                                                                         
T1025001003INTENSIVE, EXTENDED MULTIDISCIPLINARY SERVICES PROVIDED IN A CLINIC SETTING TO  Ped compr care pkg, per diem00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1025002004CHILDREN WITH COMPLEX MEDICAL, PHYSICAL, MENTAL AND PSYCHOSOCIAL IMPAIRMENTS,                                                                                                                                                                                                                                        
T1025003004PER DIEM                                                                                                                                                                                                                                                                                                             
T1026001003INTENSIVE, EXTENDED MULTIDISCIPLINARY SERVICES PROVIDED IN A CLINIC SETTING TO  Ped compr care pkg, per hour00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1026002004CHILDREN WITH COMPLEX MEDICAL, PHYSICAL, MEDICAL AND PSYCHOSOCIAL IMPAIRMENTS,                                                                                                                                                                                                                                       
T1026003004PER HOUR                                                                                                                                                                                                                                                                                                             
T1027001003FAMILY TRAINING AND COUNSELING FOR CHILD DEVELOPMENT, PER 15 MINUTES            Family training & counseling00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1028001003ASSESSMENT OF HOME, PHYSICAL AND FAMILY ENVIRONMENT, TO DETERMINE SUITABILITY   Home environment assessment 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1028002004TO MEET PATIENT'S MEDICAL NEEDS                                                                                                                                                                                                                                                                                      
T1029001003COMPREHENSIVE ENVIRONMENTAL LEAD INVESTIGATION, NOT INCLUDING LABORATORY        Dwelling lead investigation 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1029002004ANALYSIS, PER DWELLING                                                                                                                                                                                                                                                                                               
T1030001003NURSING CARE, IN THE HOME, BY REGISTERED NURSE, PER DIEM                        RN home care per diem       00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1031001003NURSING CARE, IN THE HOME, BY LICENSED PRACTICAL NURSE, PER DIEM                LPN home care per diem      00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1500001003DIAPER/INCONTINENT PANT, REUSABLE/WASHABLE, ANY SIZE, EACH                      Reusable diaper/pant        00      9                                                                                                     I                          Z2  9      0200301012005010120041231N                           
T1502001003ADMINISTRATION OF ORAL, INTRAMUSCULAR AND/OR SUBCUTANEOUS MEDICATION BY HEALTH  Medication admin visit      00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1502002004CARE AGENCY/PROFESSIONAL, PER VISIT                                                                                                                                                                                                                                                                                  
T1999001003MISCELLANEOUS THERAPEUTIC ITEMS AND SUPPLIES, RETAIL PURCHASES, NOT OTHERWISE   NOC retail items andsupplies00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T1999002004CLASSIFIED; IDENTIFY PRODUCT IN "REMARKS"                                                                                                                                                                                                                                                                            
T2001001003NON-EMERGENCY TRANSPORTATION; PATIENT ATTENDANT/ESCORT                          N-et; patient attend/escort 00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
T2002001003NON-EMERGENCY TRANSPORTATION; PER DIEM                                          N-et; per diem              00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
T2003001003NON-EMERGENCY TRANSPORTATION; ENCOUNTER/TRIP                                    N-et; encounter/trip        00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
T2004001003NON-EMERGENCY TRANSPORT; COMMERCIAL CARRIER, MULTI-PASS                         N-et; commerc carrier pass  00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
T2005001003NON-EMERGENCY TRANSPORTATION; STRETCHER VAN                                     N-et; stretcher van         00      9                                                                                                     I                          Z2  9      02002040120040701        N                           
T2006001003AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT                                  Amb response & trt, no trans00      9                                                                            A0998                    I                          Z2  9      0200204012006010120051231D                           
T2007001003TRANSPORTATION WAITING TIME, AIR AMBULANCE AND NON-EMERGENCY VEHICLE, ONE-HALF  Non-emer transport wait time00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
T2007002004(1/2) HOUR INCREMENTS                                                                                                                                                                                                                                                                                                
T2010001003PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR) LEVEL I IDENTIFICATION       PASRR Level I               00      9                                                                                                     I                      0112Z2  9      02003040120030401        N                           
T2010002004SCREENING, PER SCREEN                                                                                                                                                                                                                                                                                                
T2011001003PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR) LEVEL II EVALUATION, PER     PASRR Level II              00      9                                                                                                     I                      0113Z2  9      02003040120030401        N                           
T2011002004EVALUATION                                                                                                                                                                                                                                                                                                           
T2012001003HABILITATION, EDUCATIONAL; WAIVER, PER DIEM                                     Habil ed waiver, per diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2013001003HABILITATION, EDUCATIONAL, WAIVER; PER HOUR                                     Habil ed waiver per hour    00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2014001003HABILITATION, PREVOCATIONAL, WAIVER; PER DIEM                                   Habil prevoc waiver, per d  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2015001003HABILITATION, PREVOCATIONAL, WAIVER; PER HOUR                                   Habil prevoc waiver per hr  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2016001003HABILITATION, RESIDENTIAL, WAIVER; PER DIEM                                     Habil res waiver per diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2017001003HABILITATION, RESIDENTIAL, WAIVER; 15 MINUTES                                   Habil res waiver 15 min     00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2018001003HABILITATION, SUPPORTED EMPLOYMENT, WAIVER; PER DIEM                            Habil sup empl waiver/diem  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2019001003HABILITATION, SUPPORTED EMPLOYMENT, WAIVER; PER 15 MINUTES                      Habil sup empl waiver 15min 00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2020001003DAY HABILITATION, WAIVER; PER DIEM                                              Day habil waiver per diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2021001003DAY HABILITATION, WAIVER; PER 15 MINUTES                                        Day habil waiver per 15 min 00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2022001003CASE MANAGEMENT, PER MONTH                                                      Case management, per month  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2023001003TARGETED CASE MANAGEMENT; PER MONTH                                             Targeted case mgmt per month00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2024001003SERVICE ASSESSMENT/PLAN OF CARE DEVELOPMENT, WAIVER                             Serv asmnt/care plan waiver 00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2025001003WAIVER SERVICES; NOT OTHERWISE SPECIFIED (NOS)                                  Waiver service, nos         00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2026001003SPECIALIZED CHILDCARE, WAIVER; PER DIEM                                         Special childcare waiver/d  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2027001003SPECIALIZED CHILDCARE, WAIVER; PER 15 MINUTES                                   Spec childcare waiver 15 min00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2028001003SPECIALIZED SUPPLY, NOT OTHERWISE SPECIFIED, WAIVER                             Special supply, nos waiver  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2029001003SPECIALIZED MEDICAL EQUIPMENT, NOT OTHERWISE SPECIFIED, WAIVER                  Special med equip, noswaiver00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2030001003ASSISTED LIVING, WAIVER; PER MONTH                                              Assist living waiver/month  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2031001003ASSISTED LIVING; WAIVER, PER DIEM                                               Assist living waiver/diem   00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2032001003RESIDENTIAL CARE, NOT OTHERWISE SPECIFIED (NOS), WAIVER; PER MONTH              Res care, nos waiver/month  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2033001003RESIDENTIAL CARE, NOT OTHERWISE SPECIFIED (NOS), WAIVER; PER DIEM               Res, nos waiver per diem    00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2034001003CRISIS INTERVENTION, WAIVER; PER DIEM                                           Crisis interven waiver/diem 00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2035001003UTILITY SERVICES TO SUPPORT MEDICAL EQUIPMENT AND ASSISTIVE TECHNOLOGY/DEVICES, Utility services waiver     00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2035002004WAIVER                                                                                                                                                                                                                                                                                                               
T2036001003THERAPEUTIC CAMPING, OVERNIGHT, WAIVER; EACH SESSION                            Camp overnite waiver/session00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2037001003THERAPEUTIC CAMPING, DAY, WAIVER; EACH SESSION                                  Camp day waiver/session     00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2038001003COMMUNITY TRANSITION, WAIVER; PER SERVICE                                       Comm trans waiver/service   00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2039001003VEHICLE MODIFICATIONS, WAIVER; PER SERVICE                                      Vehicle mod waiver/service  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2040001003FINANCIAL MANAGEMENT, SELF-DIRECTED, WAIVER; PER 15 MINUTES                     Financial mgt waiver/15min  00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2041001003SUPPORTS BROKERAGE, SELF-DIRECTED, WAIVER; PER 15 MINUTES                       Support broker waiver/15 min00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2042001003HOSPICE ROUTINE HOME CARE; PER DIEM                                             Hospice routine home care   00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2043001003HOSPICE CONTINUOUS HOME CARE; PER HOUR                                          Hospice continuous home care00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2044001003HOSPICE INPATIENT RESPITE CARE; PER DIEM                                        Hospice respite care        00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2045001003HOSPICE GENERAL INPATIENT CARE; PER DIEM                                        Hospice general care        00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2046001003HOSPICE LONG TERM CARE, ROOM AND BOARD ONLY; PER DIEM                           Hospice long term care, r&b 00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2048001003BEHAVIORAL HEALTH; LONG-TERM CARE RESIDENTIAL (NON-ACUTE CARE IN A RESIDENTIAL  Bh ltc res r&b, per diem    00      9                                                                                                     I                          Z2  9      02003100120031001        N                           
T2048002004TREATMENT PROGRAM WHERE STAY IS TYPICALLY LONGER THAN 30 DAYS), WITH ROOM AND                                                                                                                                                                                                                                        
T2048003004BOARD, PER DIEM                                                                                                                                                                                                                                                                                                      
T2049001003NON-EMERGENCY TRANSPORTATION; STRETCHER VAN, MILEAGE; PER MILE                  N-ET; stretcher van, mileage00      9                                                                                                     I                          Z2  9      02004070120040701        N                           
T2101001003HUMAN BREAST MILK PROCESSING, STORAGE AND DISTRIBUTION ONLY                     Breast milk proc/store/dist 00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
T4521001003ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, SMALL, EACH          Adult size brief/diaper sm  00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4522001003ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, MEDIUM, EACH         Adult size brief/diaper med 00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4523001003ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, LARGE, EACH          Adult size brief/diaper lg  00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4524001003ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, EXTRA LARGE, EACH    Adult size brief/diaper xl  00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4525001003ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,      Adult size pull-on sm       00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4525002004SMALL SIZE, EACH                                                                                                                                                                                                                                                                                                     
T4526001003ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,      Adult size pull-on med      00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4526002004MEDIUM SIZE, EACH                                                                                                                                                                                                                                                                                                    
T4527001003ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,      Adult size pull-on lg       00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4527002004LARGE SIZE, EACH                                                                                                                                                                                                                                                                                                     
T4528001003ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,      Adult size pull-on xl       00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4528002004EXTRA LARGE SIZE, EACH                                                                                                                                                                                                                                                                                               
T4529001003PEDIATRIC SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, SMALL/MEDIUM     Ped size brief/diaper sm/med00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4529002004SIZE, EACH                                                                                                                                                                                                                                                                                                           
T4530001003PEDIATRIC SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, LARGE SIZE, EACH Ped size brief/diaper lg    00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4531001003PEDIATRIC SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE  UNDERWEAR/PULL-ON, Ped size pull-on sm/med     00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4531002004SMALL/MEDIUM SIZE, EACH                                                                                                                                                                                                                                                                                              
T4532001003PEDIATRIC SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,  Ped size pull-on lg         00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4532002004LARGE SIZE, EACH                                                                                                                                                                                                                                                                                                     
T4533001003YOUTH SIZED DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, EACH                 Youth size brief/diaper     00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4534001003YOUTH SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON, EACH Youth size pull-on          00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4535001003DISPOSABLE LINER/SHIELD/GUARD/PAD/UNDERGARMENT, FOR INCONTINENCE, EACH          Disposable liner/shield/pad 00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4536001003INCONTINENCE PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON, REUSABLE, ANY SIZE, EACH    Reusable pull-on any size   00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4537001003INCONTINENCE PRODUCT, PROTECTIVE UNDERPAD, REUSABLE, BED SIZE, EACH             Reusable underpad bed size  00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4538001003DIAPER SERVICE, REUSABLE DIAPER, EACH DIAPER                                    Diaper serv reusable diaper 00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4539001003INCONTINENCE PRODUCT, DIAPER/BRIEF, REUSABLE, ANY SIZE, EACH                    Reuse diaper/brief any size 00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4540001003INCONTINENCE PRODUCT, PROTECTIVE UNDERPAD, REUSABLE, CHAIR SIZE, EACH           Reusable underpad chair size00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
T4541001003INCONTINENCE PRODUCT, DISPOSABLE UNDERPAD, LARGE, EACH                          Large disposable underpad   00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
T4542001003INCONTINENCE PRODUCT, DISPOSABLE UNDERPAD, SMALL SIZE, EACH                     Small disposable underpad   00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
T5001001003POSITIONING SEAT FOR PERSONS WITH SPECIAL ORTHOPEDIC NEEDS, FOR USE IN VEHICLES Special position seat/vehicl00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
T5999001003SUPPLY, NOT OTHERWISE SPECIFIED                                                 Supply, nos                 00      9                                                                                                     I                          Z2  9      02004010120040101        N                           
V2020001003FRAMES, PURCHASES                                                               Vision svcs frames purchases38      A                  2130                                                                               D                          D1F Q      01985010120031001        N                           
V2025001003DELUXE FRAME                                                                    Eyeglasses delux frames     00      9                  3045.4                                                                             M                          D1F Q      01992010120031001        N                           
V2100001003SPHERE, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00, PER LENS                    Lens spher single plano 4.0038      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2101001003SPHERE, SINGLE VISION, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS      Single visn sphere 4.12-7.0038      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2102001003SPHERE, SINGLE VISION, PLUS OR MINUS  7.12 TO PLUS OR MINUS 20.00D, PER LENS    Singl visn sphere 7.12-20.0038      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2103001003SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO      Spherocylindr 4.00d/12-2.00d38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V21030020042.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                             
V2104001003SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO     Spherocylindr 4.00d/2.12-4d 38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V21040020044.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                             
V2105001003SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO     Spherocylinder 4.00d/4.25-6d38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V21050020046.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                             
V2106001003SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D  Spherocylinder 4.00d/>6.00d 38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2106002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2107001003SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00 SPHERE, Spherocylinder 4.25d/12-2d  38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2107002004.12 TO 2.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                      
V2108001003SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D       Spherocylinder 4.25d/2.12-4d38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2108002004SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                             
V2109001003SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D        Spherocylinder 4.25d/4.25-6d38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2109002004SPHERE, 4.25 TO 6.00D  CYLINDER, PER LENS                                                                                                                                                                                                                                                                            
V2110001003SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO 7.00D SPHERE, OVER 6.00D   Spherocylinder 4.25d/over 6d38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2110002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2111001003SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D       Spherocylindr 7.25d/.25-2.2538      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2111002004SPHERE, .25 TO 2.25D CYLINDER, PER LENS                                                                                                                                                                                                                                                                              
V2112001003SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D       Spherocylindr 7.25d/2.25-4d 38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2112002004SPHERE, 2.25D TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                            
V2113001003SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D       Spherocylindr 7.25d/4.25-6d 38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2113002004SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                             
V2114001003SPHEROCYLINDER, SINGLE VISION, SPHERE OVER PLUS OR MINUS 12.00D, PER LENS       Spherocylinder over 12.00d  38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2115001003LENTICULAR, (MYODISC), PER LENS, SINGLE VISION                                  Lens lenticular bifocal     38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2116001003LENTICULAR LENS, NONASPHERIC, PER LENS, SINGLE VISION                           Nonaspheric lens bifocal    38      A                                                                                                     C                          D1F Q      0198501012004010120031231N                           
V2117001003LENTICULAR, ASPHERIC, PER LENS, SINGLE VISION                                   Aspheric lens bifocal       38      A                                                                                                     C                          D1F Q      0198501012004010120031231N                           
V2118001003ANISEIKONIC LENS, SINGLE VISION                                                 Lens aniseikonic single     38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2121001003LENTICULAR LENS, PER LENS, SINGLE                                               Lenticular lens, single     38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V2199001003NOT OTHERWISE CLASSIFIED, SINGLE VISION LENS                                    Lens single vision not oth c46      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2200001003SPHERE, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS                         Lens spher bifoc plano 4.00d38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2201001003SPHERE, BIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS            Lens sphere bifocal 4.12-7.038      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2202001003SPHERE, BIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS           Lens sphere bifocal 7.12-20.38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2203001003SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO 2.00D      Lens sphcyl bifocal 4.00d/.138      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2203002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2204001003SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO 4.00D     Lens sphcy bifocal 4.00d/2.138      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2204002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2205001003SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D     Lens sphcy bifocal 4.00d/4.238      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2205002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2206001003SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D        Lens sphcy bifocal 4.00d/ove38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2206002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2207001003SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,.12   Lens sphcy bifocal 4.25-7d/.38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2207002004TO 2.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                          
V2208001003SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 2.12 Lens sphcy bifocal 4.25-7/2.38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2208002004TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                          
V2209001003SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 4.25 Lens sphcy bifocal 4.25-7/4.38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2209002004TO  6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                         
V2210001003SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, OVER Lens sphcy bifocal 4.25-7/ov38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V22100020046.00D CYLINDER,PER LENS                                                                                                                                                                                                                                                                                              
V2211001003SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, .25 Lens sphcy bifo 7.25-12/.25-38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2211002004TO 2.25D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                          
V2212001003SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,     Lens sphcyl bifo 7.25-12/2.238      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V22120020042.25 TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V2213001003SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,     Lens sphcyl bifo 7.25-12/4.238      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V22130020044.25 TO 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V2214001003SPHEROCYLINDER, BIFOCAL, SPHERE OVER PLUS OR MINUS 12.00D, PER LENS             Lens sphcyl bifocal over 12.38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2215001003LENTICULAR (MYODISC), PER LENS, BIFOCAL                                         Lens lenticular bifocal     38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2216001003LENTICULAR, NONASPHERIC, PER LENS, BIFOCAL                                      Lens lenticular nonaspheric 38      A                                                                                                     C                          D1F Q      0198501012004010120031231N                           
V2217001003LENTICULAR, ASPHERIC LENS, BIFOCAL                                              Lens lenticular aspheric bif38      A                                                                                                     C                          D1F Q      0198501012004010120031231N                           
V2218001003ANISEIKONIC, PER LENS, BIFOCAL                                                  Lens aniseikonic bifocal    38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2219001003BIFOCAL SEG WIDTH OVER 28MM                                                     Lens bifocal seg width over 38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2220001003BIFOCAL ADD OVER 3.25D                                                          Lens bifocal add over 3.25d 38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2221001003LENTICULAR LENS, PER LENS, BIFOCAL                                              Lenticular lens, bifocal    38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V2299001003SPECIALTY BIFOCAL (BY REPORT)                                                   Lens bifocal speciality     46      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2300001003SPHERE, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS                        Lens sphere trifocal 4.00d  38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2301001003SPHERE, TRIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS           Lens sphere trifocal 4.12-7.38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2302001003SPHERE, TRIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00, PER LENS           Lens sphere trifocal 7.12-2038      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2303001003SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS  4.00D SPHERE, .12-2.00D       Lens sphcy trifocal 4.0/.12-38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2303002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2304001003SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.25-4.00D       Lens sphcy trifocal 4.0/2.2538      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2304002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2305001003SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00     Lens sphcy trifocal 4.0/4.2538      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2305002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2306001003SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D       Lens sphcyl trifocal 4.00/>638      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2306002004CYLINDER, PER LENS                                                                                                                                                                                                                                                                                                   
V2307001003SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, .12 Lens sphcy trifocal 4.25-7/.38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2307002004TO 2.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                          
V2308001003SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,     Lens sphc trifocal 4.25-7/2.38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V23080020042.12 TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V2309001003SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,     Lens sphc trifocal 4.25-7/4.38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V23090020044.25 TO 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V2310001003SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,     Lens sphc trifocal 4.25-7/>638      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2310002004OVER 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                        
V2311001003SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,    Lens sphc trifo 7.25-12/.25-38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2311002004.25 TO 2.25D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                      
V2312001003SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,    Lens sphc trifo 7.25-12/2.2538      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V23120020042.25 TO 4.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V2313001003SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE,    Lens sphc trifo 7.25-12/4.2538      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V23130020044.25 TO 6.00D CYLINDER, PER LENS                                                                                                                                                                                                                                                                                     
V2314001003SPHEROCYLINDER, TRIFOCAL, SPHERE OVER PLUS OR MINUS 12 .00D, PER LENS           Lens sphcyl trifocal over 1238      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2315001003LENTICULAR, (MYODISC), PER LENS, TRIFOCAL                                       Lens lenticular trifocal    38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2316001003LENTICULAR NONASPHERIC, PER LENS, TRIFOCAL                                      Lens lenticular nonaspheric 38      A                                                                                                     C                          D1F Q      0198501012004010120031231N                           
V2317001003LENTICULAR, ASPHERIC LENS, TRIFOCAL                                             Lens lenticular aspheric tri38      A                                                                                                     C                          D1F Q      0198501012004010120031231N                           
V2318001003ANISEIKONIC LENS, TRIFOCAL                                                      Lens aniseikonic trifocal   38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2319001003TRIFOCAL SEG WIDTH OVER 28 MM                                                   Lens trifocal seg width > 2838      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2320001003TRIFOCAL ADD OVER 3.25D                                                         Lens trifocal add over 3.25d38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2321001003LENTICULAR LENS, PER LENS, TRIFOCAL                                             Lenticular lens, trifocal   38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V2399001003SPECIALTY TRIFOCAL (BY REPORT)                                                  Lens trifocal speciality    46      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2410001003VARIABLE ASPHERICITY LENS, SINGLE VISION, FULL FIELD, GLASS OR PLASTIC, PER LENSLens variab asphericity sing38      A                                                                                                     C                          D1F Q      01984010120031001        N                           
V2430001003VARIABLE ASPHERICITY LENS, BIFOCAL, FULL FIELD, GLASS OR PLASTIC, PER LENS      Lens variable asphericity bi38      A                                                                                                     C                          D1F Q      01984010120031001        N                           
V2499001003VARIABLE SPHERICITY LENS, OTHER TYPE                                            Variable asphericity lens   46      A                                                                                                     C                          D1F Q      01984010120031001        N                           
V2500001003CONTACT LENS, PMMA, SPHERICAL, PER LENS                                         Contact lens pmma spherical 38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2501001003CONTACT LENS, PMMA, TORIC OR PRISM BALLAST, PER LENS                            Cntct lens pmma-toric/prism 38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2502001003CONTACT LENS PMMA, BIFOCAL, PER LENS                                            Contact lens pmma bifocal   38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2503001003CONTACT LENS, PMMA, COLOR VISION DEFICIENCY, PER LENS                           Cntct lens pmma color vision38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2510001003CONTACT LENS, GAS PERMEABLE, SPHERICAL, PER LENS                                Cntct gas permeable sphericl38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2511001003CONTACT LENS, GAS PERMEABLE, TORIC, PRISM BALLAST, PER LENS                     Cntct toric prism ballast   38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2512001003CONTACT LENS, GAS PERMEABLE, BIFOCAL, PER LENS                                  Cntct lens gas permbl bifocl38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2513001003CONTACT LENS, GAS PERMEABLE, EXTENDED WEAR, PER LENS                            Contact lens extended wear  38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2520001003CONTACT LENS, HYDROPHILIC, SPHERICAL, PER LENS                                  Contact lens hydrophilic    38      A45-7  65-1                                                                                           D                          D1F Q      01984010120031001        N                           
V2521001003CONTACT LENS, HYDROPHILIC, TORIC, OR PRISM BALLAST, PER LENS                    Cntct lens hydrophilic toric38      A45-7  65-1                                                                                           D                          D1F Q      01985010120031001        N                           
V2522001003CONTACT LENS, HYDROPHILLIC, BIFOCAL, PER LENS                                   Cntct lens hydrophil bifocl 38      A45-7  65-1                                                                                           D                          D1F Q      01985010120031001        N                           
V2523001003CONTACT LENS, HYDROPHILIC, EXTENDED WEAR, PER LENS                              Cntct lens hydrophil extend 38      A45-7  65-1                                                                                           D                          D1F Q      01985010120031001        N                           
V2530001003CONTACT LENS, SCLERAL, GAS IMPERMEABLE, PER LENS (FOR CONTACT LENS              Contact lens gas impermeable38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2530002004MODIFICATION, SEE 92325)                                                                                                                                                                                                                                                                                             
V2531001003CONTACT LENS, SCLERAL, GAS PERMEABLE, PER LENS (FOR CONTACT LENS MODIFICATION,  Contact lens gas permeable  38      A65-3                                                                                                 D                          D1F Q      01996010120031001        N                           
V2531002004SEE 92325)                                                                                                                                                                                                                                                                                                           
V2599001003CONTACT LENS, OTHER TYPE                                                        Contact lens/es other type  46      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2600001003HAND HELD LOW VISION AIDS AND OTHER NONSPECTACLE MOUNTED AIDS                   Hand held low vision aids   46      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2610001003SINGLE LENS SPECTACLE MOUNTED LOW VISION AIDS                                   Single lens spectacle mount 46      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2615001003TELESCOPIC AND OTHER COMPOUND LENS SYSTEM, INCLUDING DISTANCE VISION            Telescop/othr compound lens 46      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2615002004TELESCOPIC, NEAR VISION TELESCOPES AND COMPOUND MICROSCOPIC LENS SYSTEM                                                                                                                                                                                                                                              
V2623001003PROSTHETIC EYE, PLASTIC, CUSTOM                                                 Plastic eye prosth custom   38      A                  2133                                                                               D                          D1F P      01985010120031001        N                           
V2624001003POLISHING/RESURFACING OF OCULAR PROSTHESIS                                      Polishing artifical eye     38      A                                                                                                     C                          D1F P      01993010120031001        N                           
V2625001003ENLARGEMENT OF OCULAR PROSTHESIS                                                Enlargemnt of eye prosthesis38      A                                                                                                     C                          D1F P      01993010120031001        N                           
V2626001003REDUCTION OF OCULAR PROSTHESIS                                                  Reduction of eye prosthesis 38      A                                                                                                     C                          D1F P      01993010120031001        N                           
V2627001003SCLERAL COVER SHELL                                                             Scleral cover shell         38      A65-3                                                                                                 D                          D1F P      01993010120031001        N                           
V2628001003FABRICATION AND FITTING OF OCULAR CONFORMER                                     Fabrication & fitting       38      A                                                                                                     C                          D1F P      01993010120031001        N                           
V2629001003PROSTHETIC EYE, OTHER TYPE                                                      Prosthetic eye other type   46      A                                                                                                     C                          D1F P      01985010120031001        N                           
V2630001003ANTERIOR CHAMBER INTRAOCULAR LENS                                               Anter chamber intraocul lens52      A                  2130                                                                               D                          D1F Q      01985010120031001        N                           
V2631001003IRIS SUPPORTED INTRAOCULAR LENS                                                 Iris support intraoclr lens 52      A                  2130                                                                               D                          D1F Q      01985010120031001        N                           
V2632001003POSTERIOR CHAMBER INTRAOCULAR LENS                                              Post chmbr intraocular lens 52      A                  2130                                                                               D                          D1F Q      01985010120031001        N                           
V2700001003BALANCE LENS, PER LENS                                                          Balance lens                38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2702001003DELUXE LENS FEATURE                                                             Deluxe lens feature         00      9                  2130B                                                                              M                          D1F Q      02005010120050101        N                           
V2710001003SLAB OFF PRISM, GLASS OR PLASTIC, PER LENS                                      Glass/plastic slab off prism38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2715001003PRISM, PER LENS                                                                 Prism lens/es               38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2718001003PRESS-ON LENS, FRESNELL PRISM, PER LENS                                         Fresnell prism press-on lens38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2730001003SPECIAL BASE CURVE, GLASS OR PLASTIC, PER LENS                                  Special base curve          38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2740001003TINT, PLASTIC, ROSE 1 OR 2 PER LENS                                             Rose tint plastic           38      A                  2130B                                                                              D                          D1F Q      0198501012004010120031231N                           
V2741001003TINT, PLASTIC, OTHER THAN ROSE 1-2, PER LENS                                    Non-rose tint plastic       38      A                  2130B                                                                              D                          D1F Q      0198501012004010120031231N                           
V2742001003TINT, GLASS ROSE 1 OR 2, PER LENS                                               Rose tint glass             38      A                  2130B                                                                              D                          D1F Q      0198501012004010120031231N                           
V2743001003TINT, GLASS OTHER THAN ROSE 1 OR 2, PER LENS                                    Non-rose tint glass         38      A                  2130B                                                                              D                          D1F Q      0198501012004010120031231N                           
V2744001003TINT, PHOTOCHROMATIC, PER LENS                                                  Tint photochromatic lens/es 38      A                  2130B                                                                              D                          D1F Q      01985010120031001        N                           
V2745001003ADDITION TO LENS; TINT, ANY COLOR, SOLID, GRADIENT OR EQUAL, EXCLUDES           Tint, any color/solid/grad  38      A                  2130.B                                                                             D                          D1F Q      02004010120050101        N                           
V2745002004PHOTOCHROMATIC, ANY LENS MATERIAL, PER LENS                                                                                                                                                                                                                                                                          
V2750001003ANTI-REFLECTIVE COATING, PER LENS                                               Anti-reflective coating     38      A                  2130B                                                                              D                          D1F Q      01985010120031001        N                           
V2755001003U-V LENS, PER LENS                                                              UV lens/es                  38      A                  2130B                                                                              D                          D1F Q      01985010120031001        N                           
V2756001003EYE GLASS CASE                                                                  Eye glass case              00      9                                                                                                     I                          Z2  Q      02004010120040101        N                           
V2760001003SCRATCH RESISTANT COATING, PER LENS                                             Scratch resistant coating   38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2761001003MIRROR COATING, ANY TYPE, SOLID, GRADIENT OR EQUAL, ANY LENS MATERIAL, PER LENS Mirror coating              38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V2762001003POLARIZATION, ANY LENS MATERIAL, PER LENS                                       Polarization, any lens      38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V2770001003OCCLUDER LENS, PER LENS                                                         Occluder lens/es            38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2780001003OVERSIZE LENS, PER LENS                                                         Oversize lens/es            38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2781001003PROGRESSIVE LENS, PER LENS                                                      Progressive lens per lens   00      9                                                                                                     C                          D1F Q      01996010120031001        N                           
V2782001003LENS, INDEX 1.54 TO 1.65 PLASTIC OR 1.60 TO 1.79 GLASS, EXCLUDES POLYCARBONATE, Lens, 1.54-1.65 p/1.60-1.79g38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V2782002004PER LENS                                                                                                                                                                                                                                                                                                             
V2783001003LENS, INDEX GREATER THAN OR EQUAL TO 1.66 PLASTIC OR GREATER THAN OR EQUAL TO   Lens, >= 1.66 p/>=1.80 g    38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V27830020041.80 GLASS, EXCLUDES POLYCARBONATE, PER LENS                                                                                                                                                                                                                                                                         
V2784001003LENS, POLYCARBONATE OR EQUAL, ANY INDEX, PER LENS                               Lens polycarb or equal      38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V2785001003PROCESSING, PRESERVING AND TRANSPORTING CORNEAL TISSUE                          Corneal tissue processing   46      A                                                                                                     C                          D1F Q      01990010120031001        N                           
V2786001003SPECIALTY OCCUPATIONAL MULTIFOCAL LENS, PER LENS                                Occupational multifocal lens38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V2788001003PRESBYOPIA CORRECTING FUNCTION OF INTRAOCULAR LENS                              Presbyopia-correct function 00      9                                          1862(a)(7)                                                 S                          Z2  Q      02006010120060101        A                           
V2790001003AMNIOTIC MEMBRANE FOR SURGICAL RECONSTRUCTION, PER PROCEDURE                    Amniotic membrane           57      A                                                                                                     C                          Z2  Q      02001010120031001        N                           
V2797001003VISION SUPPLY, ACCESSORY AND/OR SERVICE COMPONENT OF ANOTHER HCPCS VISION CODE  Vis item/svc in other code  00      9                                                                                                     C                          D1F Q      02004010120040101        N                           
V2799001003VISION SERVICE, MISCELLANEOUS                                                   Miscellaneous vision service46      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V5008001003HEARING SCREENING                                                               Hearing screening           00      9                  2320                                                                               M                          O1F K      01990010119950101        N                           
V5010001003ASSESSMENT FOR HEARING AID                                                      Assessment for hearing aid  00      9                                          1862A7                                                     S                          O1F K      01984010119950101        N                           
V5011001003FITTING/ORIENTATION/CHECKING OF HEARING AID                                     Hearing aid fitting/checking00      9                                          1862A7                                                     S                          O1F K      01990010119950101        N                           
V5014001003REPAIR/MODIFICATION OF A HEARING AID                                            Hearing aid repair/modifying00      9                                          1862A7                                                     S                          O1F K      01990010119950101        N                           
V5020001003CONFORMITY EVALUATION                                                           Conformity evaluation       00      9                                          1862A7                                                     S                          O1F K      01984010119950101        N                           
V5030001003HEARING AID, MONAURAL, BODY WORN, AIR CONDUCTION                                Body-worn hearing aid air   00      9                                          1862A7                                                     S                          O1F K      01986010119950101        N                           
V5040001003HEARING AID, MONAURAL, BODY WORN, BONE CONDUCTION                               Body-worn hearing aid bone  00      9                                          1862A7                                                     S                          O1F K      01986010119950101        N                           
V5050001003HEARING AID, MONAURAL, IN THE EAR                                               Hearing aid monaural in ear 00      9                                          1862A7                                                     S                          O1F K      01982010120010101        N                           
V5060001003HEARING AID, MONAURAL, BEHIND THE EAR                                           Behind ear hearing aid      00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5070001003GLASSES, AIR CONDUCTION                                                         Glasses air conduction      00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5080001003GLASSES, BONE CONDUCTION                                                        Glasses bone conduction     00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5090001003DISPENSING FEE, UNSPECIFIED HEARING AID                                         Hearing aid dispensing fee  00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5095001003SEMI-IMPLANTABLE MIDDLE EAR HEARING PROSTHESIS                                  Implant mid ear hearing pros00      9                                          1862A7                                                     S                          O1F K      02003010120030101        N                           
V5100001003HEARING AID, BILATERAL, BODY WORN                                               Body-worn bilat hearing aid 00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5110001003DISPENSING FEE, BILATERAL                                                       Hearing aid dispensing fee  00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5120001003BINAURAL, BODY                                                                  Body-worn binaur hearing aid00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5130001003BINAURAL, IN THE EAR                                                            In ear binaural hearing aid 00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5140001003BINAURAL, BEHIND THE EAR                                                        Behind ear binaur hearing ai00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5150001003BINAURAL, GLASSES                                                               Glasses binaural hearing aid00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5160001003DISPENSING FEE, BINAURAL                                                        Dispensing fee binaural     00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5170001003HEARING AID, CROS, IN THE EAR                                                   Within ear cros hearing aid 00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5180001003HEARING AID, CROS, BEHIND THE EAR                                               Behind ear cros hearing aid 00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5190001003HEARING AID, CROS, GLASSES                                                      Glasses cros hearing aid    00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5200001003DISPENSING FEE, CROS                                                            Cros hearing aid dispens fee00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5210001003HEARING AID, BICROS, IN THE EAR                                                 In ear bicros hearing aid   00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5220001003HEARING AID, BICROS, BEHIND THE EAR                                             Behind ear bicros hearing ai00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5230001003HEARING AID, BICROS, GLASSES                                                    Glasses bicros hearing aid  00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5240001003DISPENSING FEE, BICROS                                                          Dispensing fee bicros       00      9                                          1862A7                                                     S                          O1F K      01982010119950101        N                           
V5241001003DISPENSING FEE, MONAURAL HEARING AID, ANY TYPE                                  Dispensing fee, monaural    00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5242001003HEARING AID, ANALOG, MONAURAL, CIC (COMPLETELY IN THE EAR CANAL)                Hearing aid, monaural, cic  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5243001003HEARING AID, ANALOG, MONAURAL, ITC (IN THE CANAL)                               Hearing aid, monaural, itc  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5244001003HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, CIC                       Hearing aid, prog, mon, cic 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5245001003HEARING AID, DIGITALLY PROGRAMMABLE, ANALOG, MONAURAL, ITC                      Hearing aid, prog, mon, itc 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5246001003HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, ITE (IN THE EAR)          Hearing aid, prog, mon, ite 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5247001003HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, BTE (BEHIND THE EAR)      Hearing aid, prog, mon, bte 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5248001003HEARING AID, ANALOG, BINAURAL, CIC                                              Hearing aid, binaural, cic  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5249001003HEARING AID, ANALOG, BINAURAL, ITC                                              Hearing aid, binaural, itc  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5250001003HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, CIC                       Hearing aid, prog, bin, cic 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5251001003HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, ITC                       Hearing aid, prog, bin, itc 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5252001003HEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, ITE                              Hearing aid, prog, bin, ite 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5253001003HEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, BTE                              Hearing aid, prog, bin, bte 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5254001003HEARING AID, DIGITAL, MONAURAL, CIC                                             Hearing id, digit, mon, cic 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5255001003HEARING AID, DIGITAL, MONAURAL, ITC                                             Hearing aid, digit, mon, itc00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5256001003HEARING AID, DIGITAL, MONAURAL, ITE                                             Hearing aid, digit, mon, ite00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5257001003HEARING AID, DIGITAL, MONAURAL, BTE                                             Hearing aid, digit, mon, bte00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5258001003HEARING AID, DIGITAL, BINAURAL, CIC                                             Hearing aid, digit, bin, cic00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5259001003HEARING AID, DIGITAL, BINAURAL, ITC                                             Hearing aid, digit, bin, itc00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5260001003HEARING AID, DIGITAL, BINAURAL, ITE                                             Hearing aid, digit, bin, ite00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5261001003HEARING AID, DIGITAL, BINAURAL, BTE                                             Hearing aid, digit, bin, bte00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5262001003HEARING AID, DISPOSABLE, ANY TYPE, MONAURAL                                     Hearing aid, disp, monaural 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5263001003HEARING AID, DISPOSABLE, ANY TYPE, BINAURAL                                     Hearing aid, disp, binaural 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5264001003EAR MOLD/INSERT, NOT DISPOSABLE, ANY TYPE                                       Ear mold/insert             00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5265001003EAR MOLD/INSERT, DISPOSABLE, ANY TYPE                                           Ear mold/insert, disp       00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5266001003BATTERY FOR USE IN HEARING DEVICE                                               Battery for hearing device  00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5267001003HEARING AID SUPPLIES / ACCESSORIES                                              Hearing aid supply/accessory00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5268001003ASSISTIVE LISTENING DEVICE, TELEPHONE AMPLIFIER, ANY TYPE                       ALD Telephone Amplifier     00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5269001003ASSISTIVE LISTENING DEVICE, ALERTING, ANY TYPE                                  Alerting device, any type   00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5270001003ASSISTIVE LISTENING DEVICE, TELEVISION AMPLIFIER, ANY TYPE                      ALD, TV amplifier, any type 00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5271001003ASSISTIVE LISTENING DEVICE, TELEVISION CAPTION DECODER                          ALD, TV caption decoder     00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5272001003ASSISTIVE LISTENING DEVICE, TDD                                                 Tdd                         00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5273001003ASSISTIVE LISTENING DEVICE, FOR USE WITH COCHLEAR IMPLANT                       ALD for cochlear implant    00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5274001003ASSISTIVE LISTENING DEVICE, NOT OTHERWISE SPECIFIED                             ALD unspecified             00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5275001003EAR IMPRESSION, EACH                                                            Ear impression              00      9                                          1862A7                                                     S                          O1F K      02002010120020101        N                           
V5298001003HEARING AID, NOT OTHERWISE CLASSIFIED                                           Hearing aid noc             00      9                                          1862A7                                                     S                          O1F K      02003010120030101        N                           
V5299001003HEARING SERVICE, MISCELLANEOUS                                                  Hearing service             13      A                  2320                                                                               D                          O1F K      01982010119950101        N                           
V5336001003REPAIR/MODIFICATION OF AUGMENTATIVE COMMUNICATIVE SYSTEM OR DEVICE (EXCLUDES    Repair communication device 00      9                                          1862A7                                                     S                          O1F 1      01990010119910101        N                           
V5336002004ADAPTIVE HEARING AID)                                                                                                                                                                                                                                                                                                
V5362001003SPEECH SCREENING                                                                Speech screening            00      9                                          1862(a)(7)                                                 S                          O1F 1W     01990010120040101        N                           
V5363001003LANGUAGE SCREENING                                                              Language screening          00      9                                          1862(a)(7)                                                 S                          O1F 1W     01990010120040101        N                           
V5364001003DYSPHAGIA SCREENING                                                             Dysphagia screening         00      9                                          1862(a)(7)                                                 S                          O1F 1W     01990010120040101        N                           
