ICD-10-CM/PCS MS-DRG v44.0 Definitions Manual
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DRAFT
ICD-10-CM/PCS MS-DRG v44.0 Definitions Manual |
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| Diagnosis Code/MDC/MS-DRG Index |
| Page 34 of 75 |
| A000 B309 C673 C8441 D220 E0901 E133541 F16280 G809 H18043 H44659 H9554 I673 J1282 K51211 L282 L98A229 M13179 M2650 M62229 M80851P M84673P M929 N99524 O3100X3 O360995 O43892 P0489 Q6680 R928 S0242XD S06369A S12230G S20302D S23163D S31041S S32409G S35404S S40822A S42322P S43491D S50911D S52231N S52363P S53106A S59029A S61151D S62173S S62523D S63255S S65999S S70311S S72059B S72142K S72366J S73122A S81021D S82146S S82431R S82872Q S86219S S91103S S92226D S93325A S99142B T2220XS T24119A T362X2D T420X1A T465X3S T523X1A T63463S T81501D T8482XS Z5301 |
| DX | MDC | MS-DRG | DX | MDC | MS-DRG | DX | MDC | MS-DRG | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S20302D | 23 | 949-950 | S21209D | 23 | 949-950 | S22041B | 08 | 551-552 | ||
| S20302S | 09 | 604-605 | S21209S | 09 | 604-605 | S22041B | 24 | 963-965 | ||
| S20303A | 09 | 604-605 | S21211A | 09 | 604-605 | S22041D | 08 | 559-561 | ||
| S20303A | 24 | 963-965 | S21211A | 24 | 963-965 | S22041G | 08 | 559-561 | ||
| S20303D | 23 | 949-950 | S21211D | 23 | 949-950 | S22041K | 08 | 564-566 | ||
| S20303S | 09 | 604-605 | S21211S | 09 | 604-605 | S22041S | 08 | 551-552 | ||
| S20304A | 09 | 604-605 | S21212A | 09 | 604-605 | S22042A | 08 | 551-552 | ||
| S20304A | 24 | 963-965 | S21212A | 24 | 963-965 | S22042A | 24 | 963-965 | ||
| S20304D | 23 | 949-950 | S21212D | 23 | 949-950 | S22042B | 08 | 551-552 | ||
| S20304S | 09 | 604-605 | S21212S | 09 | 604-605 | S22042B | 24 | 963-965 | ||
| S20309A | 09 | 604-605 | S21219A | 09 | 604-605 | S22042D | 08 | 559-561 | ||
| S20309A | 24 | 963-965 | S21219A | 24 | 963-965 | S22042G | 08 | 559-561 | ||
| S20309D | 23 | 949-950 | S21219D | 23 | 949-950 | S22042K | 08 | 564-566 | ||
| S20309S | 09 | 604-605 | S21219S | 09 | 604-605 | S22042S | 08 | 551-552 | ||
| S20311A | 09 | 604-605 | S21221A | 09 | 604-605 | S22048A | 08 | 551-552 | ||
| S20311A | 24 | 963-965 | S21221A | 24 | 963-965 | S22048A | 24 | 963-965 | ||
| S20311D | 23 | 949-950 | S21221D | 23 | 949-950 | S22048B | 08 | 551-552 | ||
| S20311S | 09 | 604-605 | S21221S | 09 | 604-605 | S22048B | 24 | 963-965 | ||
| S20312A | 09 | 604-605 | S21222A | 09 | 604-605 | S22048D | 08 | 559-561 | ||
| S20312A | 24 | 963-965 | S21222A | 24 | 963-965 | S22048G | 08 | 559-561 | ||
| S20312D | 23 | 949-950 | S21222D | 23 | 949-950 | S22048K | 08 | 564-566 | ||
| S20312S | 09 | 604-605 | S21222S | 09 | 604-605 | S22048S | 08 | 551-552 | ||
| S20313A | 09 | 604-605 | S21229A | 09 | 604-605 | S22049A | 08 | 551-552 | ||
| S20313A | 24 | 963-965 | S21229A | 24 | 963-965 | S22049A | 24 | 963-965 | ||
| S20313D | 23 | 949-950 | S21229D | 23 | 949-950 | S22049B | 08 | 551-552 | ||
| S20313S | 09 | 604-605 | S21229S | 09 | 604-605 | S22049B | 24 | 963-965 | ||
| S20314A | 09 | 604-605 | S21231A | 09 | 604-605 | S22049D | 08 | 559-561 | ||
| S20314A | 24 | 963-965 | S21231A | 24 | 963-965 | S22049G | 08 | 559-561 | ||
| S20314D | 23 | 949-950 | S21231D | 23 | 949-950 | S22049K | 08 | 564-566 | ||
| S20314S | 09 | 604-605 | S21231S | 09 | 604-605 | S22049S | 08 | 551-552 | ||
| S20319A | 09 | 604-605 | S21232A | 09 | 604-605 | S22050A | 08 | 551-552 | ||
| S20319A | 24 | 963-965 | S21232A | 24 | 963-965 | S22050A | 24 | 963-965 | ||
| S20319D | 23 | 949-950 | S21232D | 23 | 949-950 | S22050B | 08 | 551-552 | ||
| S20319S | 09 | 604-605 | S21232S | 09 | 604-605 | S22050B | 24 | 963-965 | ||
| S20321A | 09 | 606-607 | S21239A | 09 | 604-605 | S22050D | 08 | 559-561 | ||
| S20321A | 24 | 963-965 | S21239A | 24 | 963-965 | S22050G | 08 | 559-561 | ||
| S20321D | 23 | 949-950 | S21239D | 23 | 949-950 | S22050K | 08 | 564-566 | ||
| S20321S | 09 | 604-605 | S21239S | 09 | 604-605 | S22050S | 08 | 551-552 | ||
| S20322A | 09 | 606-607 | S21241A | 09 | 604-605 | S22051A | 08 | 551-552 | ||
| S20322A | 24 | 963-965 | S21241A | 24 | 963-965 | S22051A | 24 | 963-965 | ||
| S20322D | 23 | 949-950 | S21241D | 23 | 949-950 | S22051B | 08 | 551-552 | ||
| S20322S | 09 | 604-605 | S21241S | 09 | 604-605 | S22051B | 24 | 963-965 | ||
| S20323A | 09 | 606-607 | S21242A | 09 | 604-605 | S22051D | 08 | 559-561 | ||
| S20323A | 24 | 963-965 | S21242A | 24 | 963-965 | S22051G | 08 | 559-561 | ||
| S20323D | 23 | 949-950 | S21242D | 23 | 949-950 | S22051K | 08 | 564-566 | ||
| S20323S | 09 | 604-605 | S21242S | 09 | 604-605 | S22051S | 08 | 551-552 | ||
| S20324A | 09 | 606-607 | S21249A | 09 | 604-605 | S22052A | 08 | 551-552 | ||
| S20324A | 24 | 963-965 | S21249A | 24 | 963-965 | S22052A | 24 | 963-965 | ||
| S20324D | 23 | 949-950 | S21249D | 23 | 949-950 | S22052B | 08 | 551-552 | ||
| S20324S | 09 | 604-605 | S21249S | 09 | 604-605 | S22052B | 24 | 963-965 | ||
| S20329A | 09 | 606-607 | S21251A | 09 | 604-605 | S22052D | 08 | 559-561 | ||
| S20329A | 24 | 963-965 | S21251A | 24 | 963-965 | S22052G | 08 | 559-561 | ||
| S20329D | 23 | 949-950 | S21251D | 23 | 949-950 | S22052K | 08 | 564-566 | ||
| S20329S | 09 | 604-605 | S21251S | 09 | 604-605 | S22052S | 08 | 551-552 | ||
| S20341A | 09 | 604-605 | S21252A | 09 | 604-605 | S22058A | 08 | 551-552 | ||
| S20341A | 24 | 963-965 | S21252A | 24 | 963-965 | S22058A | 24 | 963-965 | ||
| S20341D | 23 | 949-950 | S21252D | 23 | 949-950 | S22058B | 08 | 551-552 | ||
| S20341S | 09 | 604-605 | S21252S | 09 | 604-605 | S22058B | 24 | 963-965 | ||
| S20342A | 09 | 604-605 | S21259A | 09 | 604-605 | S22058D | 08 | 559-561 | ||
| S20342A | 24 | 963-965 | S21259A | 24 | 963-965 | S22058G | 08 | 559-561 | ||
| S20342D | 23 | 949-950 | S21259D | 23 | 949-950 | S22058K | 08 | 564-566 | ||
| S20342S | 09 | 604-605 | S21259S | 09 | 604-605 | S22058S | 08 | 551-552 | ||
| S20343A | 09 | 604-605 | S21301A | 21 | 913-914 | S22059A | 08 | 551-552 | ||
| S20343A | 24 | 963-965 | S21301A | 24 | 963-965 | S22059A | 24 | 963-965 | ||
| S20343D | 23 | 949-950 | S21301D | 23 | 949-950 | S22059B | 08 | 551-552 | ||
| S20343S | 09 | 604-605 | S21301S | 09 | 604-605 | S22059B | 24 | 963-965 | ||
| S20344A | 09 | 604-605 | S21302A | 21 | 913-914 | S22059D | 08 | 559-561 | ||
| S20344A | 24 | 963-965 | S21302A | 24 | 963-965 | S22059G | 08 | 559-561 | ||
| S20344D | 23 | 949-950 | S21302D | 23 | 949-950 | S22059K | 08 | 564-566 | ||
| S20344S | 09 | 604-605 | S21302S | 09 | 604-605 | S22059S | 08 | 551-552 | ||
| S20349A | 09 | 604-605 | S21309A | 21 | 913-914 | S22060A | 08 | 551-552 | ||
| S20349A | 24 | 963-965 | S21309A | 24 | 963-965 | S22060A | 24 | 963-965 | ||
| S20349D | 23 | 949-950 | S21309D | 23 | 949-950 | S22060B | 08 | 551-552 | ||
| S20349S | 09 | 604-605 | S21309S | 09 | 604-605 | S22060B | 24 | 963-965 | ||
| S20351A | 09 | 604-605 | S21311A | 21 | 913-914 | S22060D | 08 | 559-561 | ||
| S20351A | 24 | 963-965 | S21311A | 24 | 963-965 | S22060G | 08 | 559-561 | ||
| S20351D | 23 | 949-950 | S21311D | 23 | 949-950 | S22060K | 08 | 564-566 | ||
| S20351S | 09 | 604-605 | S21311S | 09 | 604-605 | S22060S | 08 | 551-552 | ||
| S20352A | 09 | 604-605 | S21312A | 21 | 913-914 | S22061A | 08 | 551-552 | ||
| S20352A | 24 | 963-965 | S21312A | 24 | 963-965 | S22061A | 24 | 963-965 | ||
| S20352D | 23 | 949-950 | S21312D | 23 | 949-950 | S22061B | 08 | 551-552 | ||
| S20352S | 09 | 604-605 | S21312S | 09 | 604-605 | S22061B | 24 | 963-965 | ||
| S20353A | 09 | 604-605 | S21319A | 21 | 913-914 | S22061D | 08 | 559-561 | ||
| S20353A | 24 | 963-965 | S21319A | 24 | 963-965 | S22061G | 08 | 559-561 | ||
| S20353D | 23 | 949-950 | S21319D | 23 | 949-950 | S22061K | 08 | 564-566 | ||
| S20353S | 09 | 604-605 | S21319S | 09 | 604-605 | S22061S | 08 | 551-552 | ||
| S20354A | 09 | 604-605 | S21321A | 21 | 913-914 | S22062A | 08 | 551-552 | ||
| S20354A | 24 | 963-965 | S21321A | 24 | 963-965 | S22062A | 24 | 963-965 | ||
| S20354D | 23 | 949-950 | S21321D | 23 | 949-950 | S22062B | 08 | 551-552 | ||
| S20354S | 09 | 604-605 | S21321S | 09 | 604-605 | S22062B | 24 | 963-965 | ||
| S20359A | 09 | 604-605 | S21322A | 21 | 913-914 | S22062D | 08 | 559-561 | ||
| S20359A | 24 | 963-965 | S21322A | 24 | 963-965 | S22062G | 08 | 559-561 | ||
| S20359D | 23 | 949-950 | S21322D | 23 | 949-950 | S22062K | 08 | 564-566 | ||
| S20359S | 09 | 604-605 | S21322S | 09 | 604-605 | S22062S | 08 | 551-552 | ||
| S20361A | 09 | 606-607 | S21329A | 21 | 913-914 | S22068A | 08 | 551-552 | ||
| S20361A | 24 | 963-965 | S21329A | 24 | 963-965 | S22068A | 24 | 963-965 | ||
| S20361D | 23 | 949-950 | S21329D | 23 | 949-950 | S22068B | 08 | 551-552 | ||
| S20361S | 09 | 604-605 | S21329S | 09 | 604-605 | S22068B | 24 | 963-965 | ||
| S20362A | 09 | 606-607 | S21331A | 21 | 913-914 | S22068D | 08 | 559-561 | ||
| S20362A | 24 | 963-965 | S21331A | 24 | 963-965 | S22068G | 08 | 559-561 | ||
| S20362D | 23 | 949-950 | S21331D | 23 | 949-950 | S22068K | 08 | 564-566 | ||
| S20362S | 09 | 604-605 | S21331S | 09 | 604-605 | S22068S | 08 | 551-552 | ||
| S20363A | 09 | 606-607 | S21332A | 21 | 913-914 | S22069A | 08 | 551-552 | ||
| S20363A | 24 | 963-965 | S21332A | 24 | 963-965 | S22069A | 24 | 963-965 | ||
| S20363D | 23 | 949-950 | S21332D | 23 | 949-950 | S22069B | 08 | 551-552 | ||
| S20363S | 09 | 604-605 | S21332S | 09 | 604-605 | S22069B | 24 | 963-965 | ||
| S20364A | 09 | 606-607 | S21339A | 21 | 913-914 | S22069D | 08 | 559-561 | ||
| S20364A | 24 | 963-965 | S21339A | 24 | 963-965 | S22069G | 08 | 559-561 | ||
| S20364D | 23 | 949-950 | S21339D | 23 | 949-950 | S22069K | 08 | 564-566 | ||
| S20364S | 09 | 604-605 | S21339S | 09 | 604-605 | S22069S | 08 | 551-552 | ||
| S20369A | 09 | 606-607 | S21341A | 21 | 913-914 | S22070A | 08 | 551-552 | ||
| S20369A | 24 | 963-965 | S21341A | 24 | 963-965 | S22070A | 24 | 963-965 | ||
| S20369D | 23 | 949-950 | S21341D | 23 | 949-950 | S22070B | 08 | 551-552 | ||
| S20369S | 09 | 604-605 | S21341S | 09 | 604-605 | S22070B | 24 | 963-965 | ||
| S20371A | 09 | 604-605 | S21342A | 21 | 913-914 | S22070D | 08 | 559-561 | ||
| S20371A | 24 | 963-965 | S21342A | 24 | 963-965 | S22070G | 08 | 559-561 | ||
| S20371D | 23 | 949-950 | S21342D | 23 | 949-950 | S22070K | 08 | 564-566 | ||
| S20371S | 09 | 604-605 | S21342S | 09 | 604-605 | S22070S | 08 | 551-552 | ||
| S20372A | 09 | 604-605 | S21349A | 21 | 913-914 | S22071A | 08 | 551-552 | ||
| S20372A | 24 | 963-965 | S21349A | 24 | 963-965 | S22071A | 24 | 963-965 | ||
| S20372D | 23 | 949-950 | S21349D | 23 | 949-950 | S22071B | 08 | 551-552 | ||
| S20372S | 09 | 604-605 | S21349S | 09 | 604-605 | S22071B | 24 | 963-965 | ||
| S20373A | 09 | 604-605 | S21351A | 21 | 913-914 | S22071D | 08 | 559-561 | ||
| S20373A | 24 | 963-965 | S21351A | 24 | 963-965 | S22071G | 08 | 559-561 | ||
| S20373D | 23 | 949-950 | S21351D | 23 | 949-950 | S22071K | 08 | 564-566 | ||
| S20373S | 09 | 604-605 | S21351S | 09 | 604-605 | S22071S | 08 | 551-552 | ||
| S20374A | 09 | 604-605 | S21352A | 21 | 913-914 | S22072A | 08 | 551-552 | ||
| S20374A | 24 | 963-965 | S21352A | 24 | 963-965 | S22072A | 24 | 963-965 | ||
| S20374D | 23 | 949-950 | S21352D | 23 | 949-950 | S22072B | 08 | 551-552 | ||
| S20374S | 09 | 604-605 | S21352S | 09 | 604-605 | S22072B | 24 | 963-965 | ||
| S20379A | 09 | 604-605 | S21359A | 21 | 913-914 | S22072D | 08 | 559-561 | ||
| S20379A | 24 | 963-965 | S21359A | 24 | 963-965 | S22072G | 08 | 559-561 | ||
| S20379D | 23 | 949-950 | S21359D | 23 | 949-950 | S22072K | 08 | 564-566 | ||
| S20379S | 09 | 604-605 | S21359S | 09 | 604-605 | S22072S | 08 | 551-552 | ||
| S20401A | 09 | 604-605 | S21401A | 21 | 913-914 | S22078A | 08 | 551-552 | ||
| S20401A | 24 | 963-965 | S21401A | 24 | 963-965 | S22078A | 24 | 963-965 | ||
| S20401D | 23 | 949-950 | S21401D | 23 | 949-950 | S22078B | 08 | 551-552 | ||
| S20401S | 09 | 604-605 | S21401S | 09 | 604-605 | S22078B | 24 | 963-965 | ||
| S20402A | 09 | 604-605 | S21402A | 21 | 913-914 | S22078D | 08 | 559-561 | ||
| S20402A | 24 | 963-965 | S21402A | 24 | 963-965 | S22078G | 08 | 559-561 | ||
| S20402D | 23 | 949-950 | S21402D | 23 | 949-950 | S22078K | 08 | 564-566 | ||
| S20402S | 09 | 604-605 | S21402S | 09 | 604-605 | S22078S | 08 | 551-552 | ||
| S20409A | 09 | 604-605 | S21409A | 21 | 913-914 | S22079A | 08 | 551-552 | ||
| S20409A | 24 | 963-965 | S21409A | 24 | 963-965 | S22079A | 24 | 963-965 | ||
| S20409D | 23 | 949-950 | S21409D | 23 | 949-950 | S22079B | 08 | 551-552 | ||
| S20409S | 09 | 604-605 | S21409S | 09 | 604-605 | S22079B | 24 | 963-965 | ||
| S20411A | 09 | 604-605 | S21411A | 21 | 913-914 | S22079D | 08 | 559-561 | ||
| S20411A | 24 | 963-965 | S21411A | 24 | 963-965 | S22079G | 08 | 559-561 | ||
| S20411D | 23 | 949-950 | S21411D | 23 | 949-950 | S22079K | 08 | 564-566 | ||
| S20411S | 09 | 604-605 | S21411S | 09 | 604-605 | S22079S | 08 | 551-552 | ||
| S20412A | 09 | 604-605 | S21412A | 21 | 913-914 | S22080A | 08 | 551-552 | ||
| S20412A | 24 | 963-965 | S21412A | 24 | 963-965 | S22080A | 24 | 963-965 | ||
| S20412D | 23 | 949-950 | S21412D | 23 | 949-950 | S22080B | 08 | 551-552 | ||
| S20412S | 09 | 604-605 | S21412S | 09 | 604-605 | S22080B | 24 | 963-965 | ||
| S20419A | 09 | 604-605 | S21419A | 21 | 913-914 | S22080D | 08 | 559-561 | ||
| S20419A | 24 | 963-965 | S21419A | 24 | 963-965 | S22080G | 08 | 559-561 | ||
| S20419D | 23 | 949-950 | S21419D | 23 | 949-950 | S22080K | 08 | 564-566 | ||
| S20419S | 09 | 604-605 | S21419S | 09 | 604-605 | S22080S | 08 | 551-552 | ||
| S20421A | 09 | 606-607 | S21421A | 21 | 913-914 | S22081A | 08 | 551-552 | ||
| S20421A | 24 | 963-965 | S21421A | 24 | 963-965 | S22081A | 24 | 963-965 | ||
| S20421D | 23 | 949-950 | S21421D | 23 | 949-950 | S22081B | 08 | 551-552 | ||
| S20421S | 09 | 604-605 | S21421S | 09 | 604-605 | S22081B | 24 | 963-965 | ||
| S20422A | 09 | 606-607 | S21422A | 21 | 913-914 | S22081D | 08 | 559-561 | ||
| S20422A | 24 | 963-965 | S21422A | 24 | 963-965 | S22081G | 08 | 559-561 | ||
| S20422D | 23 | 949-950 | S21422D | 23 | 949-950 | S22081K | 08 | 564-566 | ||
| S20422S | 09 | 604-605 | S21422S | 09 | 604-605 | S22081S | 08 | 551-552 | ||
| S20429A | 09 | 606-607 | S21429A | 21 | 913-914 | S22082A | 08 | 551-552 | ||
| S20429A | 24 | 963-965 | S21429A | 24 | 963-965 | S22082A | 24 | 963-965 | ||
| S20429D | 23 | 949-950 | S21429D | 23 | 949-950 | S22082B | 08 | 551-552 | ||
| S20429S | 09 | 604-605 | S21429S | 09 | 604-605 | S22082B | 24 | 963-965 | ||
| S20441A | 09 | 604-605 | S21431A | 21 | 913-914 | S22082D | 08 | 559-561 | ||
| S20441A | 24 | 963-965 | S21431A | 24 | 963-965 | S22082G | 08 | 559-561 | ||
| S20441D | 23 | 949-950 | S21431D | 23 | 949-950 | S22082K | 08 | 564-566 | ||
| S20441S | 09 | 604-605 | S21431S | 09 | 604-605 | S22082S | 08 | 551-552 | ||
| S20442A | 09 | 604-605 | S21432A | 21 | 913-914 | S22088A | 08 | 551-552 | ||
| S20442A | 24 | 963-965 | S21432A | 24 | 963-965 | S22088A | 24 | 963-965 | ||
| S20442D | 23 | 949-950 | S21432D | 23 | 949-950 | S22088B | 08 | 551-552 | ||
| S20442S | 09 | 604-605 | S21432S | 09 | 604-605 | S22088B | 24 | 963-965 | ||
| S20449A | 09 | 604-605 | S21439A | 21 | 913-914 | S22088D | 08 | 559-561 | ||
| S20449A | 24 | 963-965 | S21439A | 24 | 963-965 | S22088G | 08 | 559-561 | ||
| S20449D | 23 | 949-950 | S21439D | 23 | 949-950 | S22088K | 08 | 564-566 | ||
| S20449S | 09 | 604-605 | S21439S | 09 | 604-605 | S22088S | 08 | 551-552 | ||
| S20451A | 09 | 604-605 | S21441A | 21 | 913-914 | S22089A | 08 | 551-552 | ||
| S20451A | 24 | 963-965 | S21441A | 24 | 963-965 | S22089A | 24 | 963-965 | ||
| S20451D | 23 | 949-950 | S21441D | 23 | 949-950 | S22089B | 08 | 551-552 | ||
| S20451S | 09 | 604-605 | S21441S | 09 | 604-605 | S22089B | 24 | 963-965 | ||
| S20452A | 09 | 604-605 | S21442A | 21 | 913-914 | S22089D | 08 | 559-561 | ||
| S20452A | 24 | 963-965 | S21442A | 24 | 963-965 | S22089G | 08 | 559-561 | ||
| S20452D | 23 | 949-950 | S21442D | 23 | 949-950 | S22089K | 08 | 564-566 | ||
| S20452S | 09 | 604-605 | S21442S | 09 | 604-605 | S22089S | 08 | 551-552 | ||
| S20459A | 09 | 604-605 | S21449A | 21 | 913-914 | S2220XA | 08 | 564-566 | ||
| S20459A | 24 | 963-965 | S21449A | 24 | 963-965 | S2220XA | 24 | 963-965 | ||
| S20459D | 23 | 949-950 | S21449D | 23 | 949-950 | S2220XB | 08 | 564-566 | ||
| S20459S | 09 | 604-605 | S21449S | 09 | 604-605 | S2220XB | 24 | 963-965 | ||
| S20461A | 09 | 606-607 | S21451A | 21 | 913-914 | S2220XD | 08 | 559-561 | ||
| S20461A | 24 | 963-965 | S21451A | 24 | 963-965 | S2220XG | 08 | 559-561 | ||
| S20461D | 23 | 949-950 | S21451D | 23 | 949-950 | S2220XK | 08 | 564-566 | ||
| S20461S | 09 | 604-605 | S21451S | 09 | 604-605 | S2220XS | 08 | 551-552 | ||
| S20462A | 09 | 606-607 | S21452A | 21 | 913-914 | S2221XA | 08 | 564-566 | ||
| S20462A | 24 | 963-965 | S21452A | 24 | 963-965 | S2221XA | 24 | 963-965 | ||
| S20462D | 23 | 949-950 | S21452D | 23 | 949-950 | S2221XB | 08 | 564-566 | ||
| S20462S | 09 | 604-605 | S21452S | 09 | 604-605 | S2221XB | 24 | 963-965 | ||
| S20469A | 09 | 606-607 | S21459A | 21 | 913-914 | S2221XD | 08 | 559-561 | ||
| S20469A | 24 | 963-965 | S21459A | 24 | 963-965 | S2221XG | 08 | 559-561 | ||
| S20469D | 23 | 949-950 | S21459D | 23 | 949-950 | S2221XK | 08 | 564-566 | ||
| S20469S | 09 | 604-605 | S21459S | 09 | 604-605 | S2221XS | 08 | 551-552 | ||
| S20471A | 09 | 604-605 | S2190XA | 09 | 604-605 | S2222XA | 08 | 564-566 | ||
| S20471A | 24 | 963-965 | S2190XA | 24 | 963-965 | S2222XA | 24 | 963-965 | ||
| S20471D | 23 | 949-950 | S2190XD | 23 | 949-950 | S2222XB | 08 | 564-566 | ||
| S20471S | 09 | 604-605 | S2190XS | 09 | 604-605 | S2222XB | 24 | 963-965 | ||
| S20472A | 09 | 604-605 | S2191XA | 09 | 604-605 | S2222XD | 08 | 559-561 | ||
| S20472A | 24 | 963-965 | S2191XA | 24 | 963-965 | S2222XG | 08 | 559-561 | ||
| S20472D | 23 | 949-950 | S2191XD | 23 | 949-950 | S2222XK | 08 | 564-566 | ||
| S20472S | 09 | 604-605 | S2191XS | 09 | 604-605 | S2222XS | 08 | 551-552 | ||
| S20479A | 09 | 604-605 | S2192XA | 21 | 913-914 | S2223XA | 08 | 564-566 | ||
| S20479A | 24 | 963-965 | S2192XA | 24 | 963-965 | S2223XA | 24 | 963-965 | ||
| S20479D | 23 | 949-950 | S2192XD | 23 | 949-950 | S2223XB | 08 | 564-566 | ||
| S20479S | 09 | 604-605 | S2192XS | 09 | 604-605 | S2223XB | 24 | 963-965 | ||
| S2090XA | 09 | 604-605 | S2193XA | 09 | 604-605 | S2223XD | 08 | 559-561 | ||
| S2090XA | 24 | 963-965 | S2193XA | 24 | 963-965 | S2223XG | 08 | 559-561 | ||
| S2090XD | 23 | 949-950 | S2193XD | 23 | 949-950 | S2223XK | 08 | 564-566 | ||
| S2090XS | 09 | 604-605 | S2193XS | 09 | 604-605 | S2223XS | 08 | 551-552 | ||
| S2091XA | 09 | 604-605 | S2194XA | 21 | 913-914 | S2224XA | 08 | 564-566 | ||
| S2091XA | 24 | 963-965 | S2194XA | 24 | 963-965 | S2224XA | 24 | 963-965 | ||
| S2091XD | 23 | 949-950 | S2194XD | 23 | 949-950 | S2224XB | 08 | 564-566 | ||
| S2091XS | 09 | 604-605 | S2194XS | 09 | 604-605 | S2224XB | 24 | 963-965 | ||
| S2092XA | 09 | 606-607 | S2195XA | 09 | 604-605 | S2224XD | 08 | 559-561 | ||
| S2092XA | 24 | 963-965 | S2195XA | 24 | 963-965 | S2224XG | 08 | 559-561 | ||
| S2092XD | 23 | 949-950 | S2195XD | 23 | 949-950 | S2224XK | 08 | 564-566 | ||
| S2092XS | 09 | 604-605 | S2195XS | 09 | 604-605 | S2224XS | 08 | 551-552 | ||
| S2094XA | 09 | 604-605 | S22000A | 08 | 551-552 | S2231XA | 04 | 205-206 | ||
| S2094XA | 24 | 963-965 | S22000A | 24 | 963-965 | S2231XA | 24 | 963-965 | ||
| S2094XD | 23 | 949-950 | S22000B | 08 | 551-552 | S2231XB | 04 | 183-185 | ||
| S2094XS | 09 | 604-605 | S22000B | 24 | 963-965 | S2231XB | 24 | 963-965 | ||
| S2095XA | 09 | 604-605 | S22000D | 08 | 559-561 | S2231XD | 08 | 559-561 | ||
| S2095XA | 24 | 963-965 | S22000G | 08 | 559-561 | S2231XG | 08 | 559-561 | ||
| S2095XD | 23 | 949-950 | S22000K | 08 | 564-566 | S2231XK | 08 | 564-566 | ||
| S2095XS | 09 | 604-605 | S22000S | 08 | 551-552 | S2231XS | 08 | 551-552 | ||
| S2096XA | 09 | 606-607 | S22001A | 08 | 551-552 | S2232XA | 04 | 205-206 | ||
| S2096XA | 24 | 963-965 | S22001A | 24 | 963-965 | S2232XA | 24 | 963-965 | ||
| S2096XD | 23 | 949-950 | S22001B | 08 | 551-552 | S2232XB | 04 | 183-185 | ||
| S2096XS | 09 | 604-605 | S22001B | 24 | 963-965 | S2232XB | 24 | 963-965 | ||
| S2097XA | 09 | 604-605 | S22001D | 08 | 559-561 | S2232XD | 08 | 559-561 | ||
| S2097XA | 24 | 963-965 | S22001G | 08 | 559-561 | S2232XG | 08 | 559-561 | ||
| S2097XD | 23 | 949-950 | S22001K | 08 | 564-566 | S2232XK | 08 | 564-566 | ||
| S2097XS | 09 | 604-605 | S22001S | 08 | 551-552 | S2232XS | 08 | 551-552 | ||
| S21001A | 09 | 604-605 | S22002A | 08 | 551-552 | S2239XA | 04 | 205-206 | ||
| S21001A | 24 | 963-965 | S22002A | 24 | 963-965 | S2239XA | 24 | 963-965 | ||
| S21001D | 23 | 949-950 | S22002B | 08 | 551-552 | S2239XB | 04 | 183-185 | ||
| S21001S | 09 | 604-605 | S22002B | 24 | 963-965 | S2239XB | 24 | 963-965 | ||
| S21002A | 09 | 604-605 | S22002D | 08 | 559-561 | S2239XD | 08 | 559-561 | ||
| S21002A | 24 | 963-965 | S22002G | 08 | 559-561 | S2239XG | 08 | 559-561 | ||
| S21002D | 23 | 949-950 | S22002K | 08 | 564-566 | S2239XK | 08 | 564-566 | ||
| S21002S | 09 | 604-605 | S22002S | 08 | 551-552 | S2239XS | 08 | 551-552 | ||
| S21009A | 09 | 604-605 | S22008A | 08 | 551-552 | S2241XA | 04 | 183-185 | ||
| S21009A | 24 | 963-965 | S22008A | 24 | 963-965 | S2241XA | 24 | 963-965 | ||
| S21009D | 23 | 949-950 | S22008B | 08 | 551-552 | S2241XB | 04 | 183-185 | ||
| S21009S | 09 | 604-605 | S22008B | 24 | 963-965 | S2241XB | 24 | 963-965 | ||
| S21011A | 09 | 604-605 | S22008D | 08 | 559-561 | S2241XD | 08 | 559-561 | ||
| S21011A | 24 | 963-965 | S22008G | 08 | 559-561 | S2241XG | 08 | 559-561 | ||
| S21011D | 23 | 949-950 | S22008K | 08 | 564-566 | S2241XK | 08 | 564-566 | ||
| S21011S | 09 | 604-605 | S22008S | 08 | 551-552 | S2241XS | 08 | 551-552 | ||
| S21012A | 09 | 604-605 | S22009A | 08 | 551-552 | S2242XA | 04 | 183-185 | ||
| S21012A | 24 | 963-965 | S22009A | 24 | 963-965 | S2242XA | 24 | 963-965 | ||
| S21012D | 23 | 949-950 | S22009B | 08 | 551-552 | S2242XB | 04 | 183-185 | ||
| S21012S | 09 | 604-605 | S22009B | 24 | 963-965 | S2242XB | 24 | 963-965 | ||
| S21019A | 09 | 604-605 | S22009D | 08 | 559-561 | S2242XD | 08 | 559-561 | ||
| S21019A | 24 | 963-965 | S22009G | 08 | 559-561 | S2242XG | 08 | 559-561 | ||
| S21019D | 23 | 949-950 | S22009K | 08 | 564-566 | S2242XK | 08 | 564-566 | ||
| S21019S | 09 | 604-605 | S22009S | 08 | 551-552 | S2242XS | 08 | 551-552 | ||
| S21021A | 09 | 604-605 | S22010A | 08 | 551-552 | S2243XA | 04 | 183-185 | ||
| S21021A | 24 | 963-965 | S22010A | 24 | 963-965 | S2243XA | 24 | 963-965 | ||
| S21021D | 23 | 949-950 | S22010B | 08 | 551-552 | S2243XB | 04 | 183-185 | ||
| S21021S | 09 | 604-605 | S22010B | 24 | 963-965 | S2243XB | 24 | 963-965 | ||
| S21022A | 09 | 604-605 | S22010D | 08 | 559-561 | S2243XD | 08 | 559-561 | ||
| S21022A | 24 | 963-965 | S22010G | 08 | 559-561 | S2243XG | 08 | 559-561 | ||
| S21022D | 23 | 949-950 | S22010K | 08 | 564-566 | S2243XK | 08 | 564-566 | ||
| S21022S | 09 | 604-605 | S22010S | 08 | 551-552 | S2243XS | 08 | 551-552 | ||
| S21029A | 09 | 604-605 | S22011A | 08 | 551-552 | S2249XA | 04 | 183-185 | ||
| S21029A | 24 | 963-965 | S22011A | 24 | 963-965 | S2249XA | 24 | 963-965 | ||
| S21029D | 23 | 949-950 | S22011B | 08 | 551-552 | S2249XB | 04 | 183-185 | ||
| S21029S | 09 | 604-605 | S22011B | 24 | 963-965 | S2249XB | 24 | 963-965 | ||
| S21031A | 09 | 604-605 | S22011D | 08 | 559-561 | S2249XD | 08 | 559-561 | ||
| S21031A | 24 | 963-965 | S22011G | 08 | 559-561 | S2249XG | 08 | 559-561 | ||
| S21031D | 23 | 949-950 | S22011K | 08 | 564-566 | S2249XK | 08 | 564-566 | ||
| S21031S | 09 | 604-605 | S22011S | 08 | 551-552 | S2249XS | 08 | 551-552 | ||
| S21032A | 09 | 604-605 | S22012A | 08 | 551-552 | S225XXA | 04 | 183-185 | ||
| S21032A | 24 | 963-965 | S22012A | 24 | 963-965 | S225XXA | 24 | 963-965 | ||
| S21032D | 23 | 949-950 | S22012B | 08 | 551-552 | S225XXB | 04 | 183-185 | ||
| S21032S | 09 | 604-605 | S22012B | 24 | 963-965 | S225XXB | 24 | 963-965 | ||
| S21039A | 09 | 604-605 | S22012D | 08 | 559-561 | S225XXD | 08 | 559-561 | ||
| S21039A | 24 | 963-965 | S22012G | 08 | 559-561 | S225XXG | 08 | 559-561 | ||
| S21039D | 23 | 949-950 | S22012K | 08 | 564-566 | S225XXK | 08 | 564-566 | ||
| S21039S | 09 | 604-605 | S22012S | 08 | 551-552 | S225XXS | 08 | 551-552 | ||
| S21041A | 09 | 604-605 | S22018A | 08 | 551-552 | S229XXA | 08 | 564-566 | ||
| S21041A | 24 | 963-965 | S22018A | 24 | 963-965 | S229XXA | 24 | 963-965 | ||
| S21041D | 23 | 949-950 | S22018B | 08 | 551-552 | S229XXB | 08 | 564-566 | ||
| S21041S | 09 | 604-605 | S22018B | 24 | 963-965 | S229XXB | 24 | 963-965 | ||
| S21042A | 09 | 604-605 | S22018D | 08 | 559-561 | S229XXD | 08 | 559-561 | ||
| S21042A | 24 | 963-965 | S22018G | 08 | 559-561 | S229XXG | 08 | 559-561 | ||
| S21042D | 23 | 949-950 | S22018K | 08 | 564-566 | S229XXK | 08 | 564-566 | ||
| S21042S | 09 | 604-605 | S22018S | 08 | 551-552 | S229XXS | 08 | 551-552 | ||
| S21049A | 09 | 604-605 | S22019A | 08 | 551-552 | S230XXA | 08 | 551-552 | ||
| S21049A | 24 | 963-965 | S22019A | 24 | 963-965 | S230XXA | 24 | 963-965 | ||
| S21049D | 23 | 949-950 | S22019B | 08 | 551-552 | S230XXD | 23 | 949-950 | ||
| S21049S | 09 | 604-605 | S22019B | 24 | 963-965 | S230XXS | 08 | 562-563 | ||
| S21051A | 09 | 604-605 | S22019D | 08 | 559-561 | S23100A | 08 | 551-552 | ||
| S21051A | 24 | 963-965 | S22019G | 08 | 559-561 | S23100A | 24 | 963-965 | ||
| S21051D | 23 | 949-950 | S22019K | 08 | 564-566 | S23100D | 23 | 949-950 | ||
| S21051S | 09 | 604-605 | S22019S | 08 | 551-552 | S23100S | 08 | 562-563 | ||
| S21052A | 09 | 604-605 | S22020A | 08 | 551-552 | S23101A | 08 | 551-552 | ||
| S21052A | 24 | 963-965 | S22020A | 24 | 963-965 | S23101A | 24 | 963-965 | ||
| S21052D | 23 | 949-950 | S22020B | 08 | 551-552 | S23101D | 23 | 949-950 | ||
| S21052S | 09 | 604-605 | S22020B | 24 | 963-965 | S23101S | 08 | 562-563 | ||
| S21059A | 09 | 604-605 | S22020D | 08 | 559-561 | S23110A | 08 | 551-552 | ||
| S21059A | 24 | 963-965 | S22020G | 08 | 559-561 | S23110A | 24 | 963-965 | ||
| S21059D | 23 | 949-950 | S22020K | 08 | 564-566 | S23110D | 23 | 949-950 | ||
| S21059S | 09 | 604-605 | S22020S | 08 | 551-552 | S23110S | 08 | 562-563 | ||
| S21101A | 09 | 604-605 | S22021A | 08 | 551-552 | S23111A | 08 | 551-552 | ||
| S21101A | 24 | 963-965 | S22021A | 24 | 963-965 | S23111A | 24 | 963-965 | ||
| S21101D | 23 | 949-950 | S22021B | 08 | 551-552 | S23111D | 23 | 949-950 | ||
| S21101S | 09 | 604-605 | S22021B | 24 | 963-965 | S23111S | 08 | 562-563 | ||
| S21102A | 09 | 604-605 | S22021D | 08 | 559-561 | S23120A | 08 | 551-552 | ||
| S21102A | 24 | 963-965 | S22021G | 08 | 559-561 | S23120A | 24 | 963-965 | ||
| S21102D | 23 | 949-950 | S22021K | 08 | 564-566 | S23120D | 23 | 949-950 | ||
| S21102S | 09 | 604-605 | S22021S | 08 | 551-552 | S23120S | 08 | 562-563 | ||
| S21109A | 09 | 604-605 | S22022A | 08 | 551-552 | S23121A | 08 | 551-552 | ||
| S21109A | 24 | 963-965 | S22022A | 24 | 963-965 | S23121A | 24 | 963-965 | ||
| S21109D | 23 | 949-950 | S22022B | 08 | 551-552 | S23121D | 23 | 949-950 | ||
| S21109S | 09 | 604-605 | S22022B | 24 | 963-965 | S23121S | 08 | 562-563 | ||
| S21111A | 09 | 604-605 | S22022D | 08 | 559-561 | S23122A | 08 | 551-552 | ||
| S21111A | 24 | 963-965 | S22022G | 08 | 559-561 | S23122A | 24 | 963-965 | ||
| S21111D | 23 | 949-950 | S22022K | 08 | 564-566 | S23122D | 23 | 949-950 | ||
| S21111S | 09 | 604-605 | S22022S | 08 | 551-552 | S23122S | 08 | 562-563 | ||
| S21112A | 09 | 604-605 | S22028A | 08 | 551-552 | S23123A | 08 | 551-552 | ||
| S21112A | 24 | 963-965 | S22028A | 24 | 963-965 | S23123A | 24 | 963-965 | ||
| S21112D | 23 | 949-950 | S22028B | 08 | 551-552 | S23123D | 23 | 949-950 | ||
| S21112S | 09 | 604-605 | S22028B | 24 | 963-965 | S23123S | 08 | 562-563 | ||
| S21119A | 09 | 604-605 | S22028D | 08 | 559-561 | S23130A | 08 | 551-552 | ||
| S21119A | 24 | 963-965 | S22028G | 08 | 559-561 | S23130A | 24 | 963-965 | ||
| S21119D | 23 | 949-950 | S22028K | 08 | 564-566 | S23130D | 23 | 949-950 | ||
| S21119S | 09 | 604-605 | S22028S | 08 | 551-552 | S23130S | 08 | 562-563 | ||
| S21121A | 21 | 913-914 | S22029A | 08 | 551-552 | S23131A | 08 | 551-552 | ||
| S21121A | 24 | 963-965 | S22029A | 24 | 963-965 | S23131A | 24 | 963-965 | ||
| S21121D | 23 | 949-950 | S22029B | 08 | 551-552 | S23131D | 23 | 949-950 | ||
| S21121S | 09 | 604-605 | S22029B | 24 | 963-965 | S23131S | 08 | 562-563 | ||
| S21122A | 21 | 913-914 | S22029D | 08 | 559-561 | S23132A | 08 | 551-552 | ||
| S21122A | 24 | 963-965 | S22029G | 08 | 559-561 | S23132A | 24 | 963-965 | ||
| S21122D | 23 | 949-950 | S22029K | 08 | 564-566 | S23132D | 23 | 949-950 | ||
| S21122S | 09 | 604-605 | S22029S | 08 | 551-552 | S23132S | 08 | 562-563 | ||
| S21129A | 21 | 913-914 | S22030A | 08 | 551-552 | S23133A | 08 | 551-552 | ||
| S21129A | 24 | 963-965 | S22030A | 24 | 963-965 | S23133A | 24 | 963-965 | ||
| S21129D | 23 | 949-950 | S22030B | 08 | 551-552 | S23133D | 23 | 949-950 | ||
| S21129S | 09 | 604-605 | S22030B | 24 | 963-965 | S23133S | 08 | 562-563 | ||
| S21131A | 09 | 604-605 | S22030D | 08 | 559-561 | S23140A | 08 | 551-552 | ||
| S21131A | 24 | 963-965 | S22030G | 08 | 559-561 | S23140A | 24 | 963-965 | ||
| S21131D | 23 | 949-950 | S22030K | 08 | 564-566 | S23140D | 23 | 949-950 | ||
| S21131S | 09 | 604-605 | S22030S | 08 | 551-552 | S23140S | 08 | 562-563 | ||
| S21132A | 09 | 604-605 | S22031A | 08 | 551-552 | S23141A | 08 | 551-552 | ||
| S21132A | 24 | 963-965 | S22031A | 24 | 963-965 | S23141A | 24 | 963-965 | ||
| S21132D | 23 | 949-950 | S22031B | 08 | 551-552 | S23141D | 23 | 949-950 | ||
| S21132S | 09 | 604-605 | S22031B | 24 | 963-965 | S23141S | 08 | 562-563 | ||
| S21139A | 09 | 604-605 | S22031D | 08 | 559-561 | S23142A | 08 | 551-552 | ||
| S21139A | 24 | 963-965 | S22031G | 08 | 559-561 | S23142A | 24 | 963-965 | ||
| S21139D | 23 | 949-950 | S22031K | 08 | 564-566 | S23142D | 23 | 949-950 | ||
| S21139S | 09 | 604-605 | S22031S | 08 | 551-552 | S23142S | 08 | 562-563 | ||
| S21141A | 21 | 913-914 | S22032A | 08 | 551-552 | S23143A | 08 | 551-552 | ||
| S21141A | 24 | 963-965 | S22032A | 24 | 963-965 | S23143A | 24 | 963-965 | ||
| S21141D | 23 | 949-950 | S22032B | 08 | 551-552 | S23143D | 23 | 949-950 | ||
| S21141S | 09 | 604-605 | S22032B | 24 | 963-965 | S23143S | 08 | 562-563 | ||
| S21142A | 21 | 913-914 | S22032D | 08 | 559-561 | S23150A | 08 | 551-552 | ||
| S21142A | 24 | 963-965 | S22032G | 08 | 559-561 | S23150A | 24 | 963-965 | ||
| S21142D | 23 | 949-950 | S22032K | 08 | 564-566 | S23150D | 23 | 949-950 | ||
| S21142S | 09 | 604-605 | S22032S | 08 | 551-552 | S23150S | 08 | 562-563 | ||
| S21149A | 21 | 913-914 | S22038A | 08 | 551-552 | S23151A | 08 | 551-552 | ||
| S21149A | 24 | 963-965 | S22038A | 24 | 963-965 | S23151A | 24 | 963-965 | ||
| S21149D | 23 | 949-950 | S22038B | 08 | 551-552 | S23151D | 23 | 949-950 | ||
| S21149S | 09 | 604-605 | S22038B | 24 | 963-965 | S23151S | 08 | 562-563 | ||
| S21151A | 09 | 604-605 | S22038D | 08 | 559-561 | S23152A | 08 | 551-552 | ||
| S21151A | 24 | 963-965 | S22038G | 08 | 559-561 | S23152A | 24 | 963-965 | ||
| S21151D | 23 | 949-950 | S22038K | 08 | 564-566 | S23152D | 23 | 949-950 | ||
| S21151S | 09 | 604-605 | S22038S | 08 | 551-552 | S23152S | 08 | 562-563 | ||
| S21152A | 09 | 604-605 | S22039A | 08 | 551-552 | S23153A | 08 | 551-552 | ||
| S21152A | 24 | 963-965 | S22039A | 24 | 963-965 | S23153A | 24 | 963-965 | ||
| S21152D | 23 | 949-950 | S22039B | 08 | 551-552 | S23153D | 23 | 949-950 | ||
| S21152S | 09 | 604-605 | S22039B | 24 | 963-965 | S23153S | 08 | 562-563 | ||
| S21159A | 09 | 604-605 | S22039D | 08 | 559-561 | S23160A | 08 | 551-552 | ||
| S21159A | 24 | 963-965 | S22039G | 08 | 559-561 | S23160A | 24 | 963-965 | ||
| S21159D | 23 | 949-950 | S22039K | 08 | 564-566 | S23160D | 23 | 949-950 | ||
| S21159S | 09 | 604-605 | S22039S | 08 | 551-552 | S23160S | 08 | 562-563 | ||
| S21201A | 09 | 604-605 | S22040A | 08 | 551-552 | S23161A | 08 | 551-552 | ||
| S21201A | 24 | 963-965 | S22040A | 24 | 963-965 | S23161A | 24 | 963-965 | ||
| S21201D | 23 | 949-950 | S22040B | 08 | 551-552 | S23161D | 23 | 949-950 | ||
| S21201S | 09 | 604-605 | S22040B | 24 | 963-965 | S23161S | 08 | 562-563 | ||
| S21202A | 09 | 604-605 | S22040D | 08 | 559-561 | S23162A | 08 | 551-552 | ||
| S21202A | 24 | 963-965 | S22040G | 08 | 559-561 | S23162A | 24 | 963-965 | ||
| S21202D | 23 | 949-950 | S22040K | 08 | 564-566 | S23162D | 23 | 949-950 | ||
| S21202S | 09 | 604-605 | S22040S | 08 | 551-552 | S23162S | 08 | 562-563 | ||
| S21209A | 09 | 604-605 | S22041A | 08 | 551-552 | S23163A | 08 | 551-552 | ||
| S21209A | 24 | 963-965 | S22041A | 24 | 963-965 | S23163A | 24 | 963-965 |
| | |
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Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244 25 Mar 2026 13:16:25 CMS, code-revision=381, description-revision=1473 |