ICD-10-CM/PCS MS-DRG v38.0 Definitions Manual
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ICD-10-CM/PCS MS-DRG v38.0 Definitions Manual |
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| Diagnosis Code/MDC/MS-DRG Index |
| Page 39 of 74 |
| A000 B303 C579 C8444 D3131 E093513 E13638 F423 H02202 H30121 H59031 I5089 I70722 K006 K9089 L97103 M10361 M247 M60159 M80052S M84633D M90569 N8341 O2942 O3623X4 O6000 P258 Q72819 S00221S S02622K S066X0D S12651B S21101S S25319D S31612D S32472S S36513D S42031B S42424B S46019S S52033M S52264P S52521A S55802S S60041A S61341A S62304D S62643B S63497A S66411A S72019D S72102S S72309C S72435C S76309S S82033M S82235R S82492B S83222D S89132P S92016A S92401P S95999S T17998A T23042A T25392D T38803S T438X5D T492X6D T595X4A T7462XA T8332XD Z22322 Z95820 |
| DX | MDC | MS-DRG | DX | MDC | MS-DRG | DX | MDC | MS-DRG | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S42424B | 08 | 562-563 | S4290XD | 08 | 559-561 | S43432D | 23 | 949-950 | ||
| S42424B | 24 | 955-965 | S4290XG | 08 | 559-561 | S43432S | 08 | 562-563 | ||
| S42424D | 08 | 559-561 | S4290XK | 08 | 564-566 | S43439A | 08 | 562-563 | ||
| S42424G | 08 | 559-561 | S4290XP | 08 | 564-566 | S43439A | 24 | 955-965 | ||
| S42424K | 08 | 564-566 | S4290XS | 08 | 559-561 | S43439D | 23 | 949-950 | ||
| S42424P | 08 | 564-566 | S4291XA | 08 | 562-563 | S43439S | 08 | 562-563 | ||
| S42424S | 08 | 559-561 | S4291XA | 24 | 955-965 | S43491A | 08 | 562-563 | ||
| S42425A | 08 | 562-563 | S4291XB | 08 | 562-563 | S43491A | 24 | 955-965 | ||
| S42425A | 24 | 955-965 | S4291XB | 24 | 955-965 | S43491D | 23 | 949-950 | ||
| S42425B | 08 | 562-563 | S4291XD | 08 | 559-561 | S43491S | 08 | 562-563 | ||
| S42425B | 24 | 955-965 | S4291XG | 08 | 559-561 | S43492A | 08 | 562-563 | ||
| S42425D | 08 | 559-561 | S4291XK | 08 | 564-566 | S43492A | 24 | 955-965 | ||
| S42425G | 08 | 559-561 | S4291XP | 08 | 564-566 | S43492D | 23 | 949-950 | ||
| S42425K | 08 | 564-566 | S4291XS | 08 | 559-561 | S43492S | 08 | 562-563 | ||
| S42425P | 08 | 564-566 | S4292XA | 08 | 562-563 | S43499A | 08 | 562-563 | ||
| S42425S | 08 | 559-561 | S4292XA | 24 | 955-965 | S43499A | 24 | 955-965 | ||
| S42426A | 08 | 562-563 | S4292XB | 08 | 562-563 | S43499D | 23 | 949-950 | ||
| S42426A | 24 | 955-965 | S4292XB | 24 | 955-965 | S43499S | 08 | 562-563 | ||
| S42426B | 08 | 562-563 | S4292XD | 08 | 559-561 | S4350XA | 08 | 562-563 | ||
| S42426B | 24 | 955-965 | S4292XG | 08 | 559-561 | S4350XA | 24 | 955-965 | ||
| S42426D | 08 | 559-561 | S4292XK | 08 | 564-566 | S4350XD | 23 | 949-950 | ||
| S42426G | 08 | 559-561 | S4292XP | 08 | 564-566 | S4350XS | 08 | 562-563 | ||
| S42426K | 08 | 564-566 | S4292XS | 08 | 559-561 | S4351XA | 08 | 562-563 | ||
| S42426P | 08 | 564-566 | S43001A | 08 | 562-563 | S4351XA | 24 | 955-965 | ||
| S42426S | 08 | 559-561 | S43001A | 24 | 955-965 | S4351XD | 23 | 949-950 | ||
| S42431A | 08 | 562-563 | S43001D | 23 | 949-950 | S4351XS | 08 | 562-563 | ||
| S42431A | 24 | 955-965 | S43001S | 08 | 562-563 | S4352XA | 08 | 562-563 | ||
| S42431B | 08 | 562-563 | S43002A | 08 | 562-563 | S4352XA | 24 | 955-965 | ||
| S42431B | 24 | 955-965 | S43002A | 24 | 955-965 | S4352XD | 23 | 949-950 | ||
| S42431D | 08 | 559-561 | S43002D | 23 | 949-950 | S4352XS | 08 | 562-563 | ||
| S42431G | 08 | 559-561 | S43002S | 08 | 562-563 | S4360XA | 08 | 562-563 | ||
| S42431K | 08 | 564-566 | S43003A | 08 | 562-563 | S4360XA | 24 | 955-965 | ||
| S42431P | 08 | 564-566 | S43003A | 24 | 955-965 | S4360XD | 23 | 949-950 | ||
| S42431S | 08 | 559-561 | S43003D | 23 | 949-950 | S4360XS | 08 | 562-563 | ||
| S42432A | 08 | 562-563 | S43003S | 08 | 562-563 | S4361XA | 08 | 562-563 | ||
| S42432A | 24 | 955-965 | S43004A | 08 | 562-563 | S4361XA | 24 | 955-965 | ||
| S42432B | 08 | 562-563 | S43004A | 24 | 955-965 | S4361XD | 23 | 949-950 | ||
| S42432B | 24 | 955-965 | S43004D | 23 | 949-950 | S4361XS | 08 | 562-563 | ||
| S42432D | 08 | 559-561 | S43004S | 08 | 562-563 | S4362XA | 08 | 562-563 | ||
| S42432G | 08 | 559-561 | S43005A | 08 | 562-563 | S4362XA | 24 | 955-965 | ||
| S42432K | 08 | 564-566 | S43005A | 24 | 955-965 | S4362XD | 23 | 949-950 | ||
| S42432P | 08 | 564-566 | S43005D | 23 | 949-950 | S4362XS | 08 | 562-563 | ||
| S42432S | 08 | 559-561 | S43005S | 08 | 562-563 | S4380XA | 08 | 562-563 | ||
| S42433A | 08 | 562-563 | S43006A | 08 | 562-563 | S4380XA | 24 | 955-965 | ||
| S42433A | 24 | 955-965 | S43006A | 24 | 955-965 | S4380XD | 23 | 949-950 | ||
| S42433B | 08 | 562-563 | S43006D | 23 | 949-950 | S4380XS | 08 | 562-563 | ||
| S42433B | 24 | 955-965 | S43006S | 08 | 562-563 | S4381XA | 08 | 562-563 | ||
| S42433D | 08 | 559-561 | S43011A | 08 | 562-563 | S4381XA | 24 | 955-965 | ||
| S42433G | 08 | 559-561 | S43011A | 24 | 955-965 | S4381XD | 23 | 949-950 | ||
| S42433K | 08 | 564-566 | S43011D | 23 | 949-950 | S4381XS | 08 | 562-563 | ||
| S42433P | 08 | 564-566 | S43011S | 08 | 562-563 | S4382XA | 08 | 562-563 | ||
| S42433S | 08 | 559-561 | S43012A | 08 | 562-563 | S4382XA | 24 | 955-965 | ||
| S42434A | 08 | 562-563 | S43012A | 24 | 955-965 | S4382XD | 23 | 949-950 | ||
| S42434A | 24 | 955-965 | S43012D | 23 | 949-950 | S4382XS | 08 | 562-563 | ||
| S42434B | 08 | 562-563 | S43012S | 08 | 562-563 | S4390XA | 08 | 562-563 | ||
| S42434B | 24 | 955-965 | S43013A | 08 | 562-563 | S4390XA | 24 | 955-965 | ||
| S42434D | 08 | 559-561 | S43013A | 24 | 955-965 | S4390XD | 23 | 949-950 | ||
| S42434G | 08 | 559-561 | S43013D | 23 | 949-950 | S4390XS | 08 | 562-563 | ||
| S42434K | 08 | 564-566 | S43013S | 08 | 562-563 | S4391XA | 08 | 562-563 | ||
| S42434P | 08 | 564-566 | S43014A | 08 | 562-563 | S4391XA | 24 | 955-965 | ||
| S42434S | 08 | 559-561 | S43014A | 24 | 955-965 | S4391XD | 23 | 949-950 | ||
| S42435A | 08 | 562-563 | S43014D | 23 | 949-950 | S4391XS | 08 | 562-563 | ||
| S42435A | 24 | 955-965 | S43014S | 08 | 562-563 | S4392XA | 08 | 562-563 | ||
| S42435B | 08 | 562-563 | S43015A | 08 | 562-563 | S4392XA | 24 | 955-965 | ||
| S42435B | 24 | 955-965 | S43015A | 24 | 955-965 | S4392XD | 23 | 949-950 | ||
| S42435D | 08 | 559-561 | S43015D | 23 | 949-950 | S4392XS | 08 | 562-563 | ||
| S42435G | 08 | 559-561 | S43015S | 08 | 562-563 | S4400XA | 01 | 073-074 | ||
| S42435K | 08 | 564-566 | S43016A | 08 | 562-563 | S4400XA | 24 | 955-965 | ||
| S42435P | 08 | 564-566 | S43016A | 24 | 955-965 | S4400XD | 23 | 949-950 | ||
| S42435S | 08 | 559-561 | S43016D | 23 | 949-950 | S4400XS | 01 | 091-093 | ||
| S42436A | 08 | 562-563 | S43016S | 08 | 562-563 | S4401XA | 01 | 073-074 | ||
| S42436A | 24 | 955-965 | S43021A | 08 | 562-563 | S4401XA | 24 | 955-965 | ||
| S42436B | 08 | 562-563 | S43021A | 24 | 955-965 | S4401XD | 23 | 949-950 | ||
| S42436B | 24 | 955-965 | S43021D | 23 | 949-950 | S4401XS | 01 | 091-093 | ||
| S42436D | 08 | 559-561 | S43021S | 08 | 562-563 | S4402XA | 01 | 073-074 | ||
| S42436G | 08 | 559-561 | S43022A | 08 | 562-563 | S4402XA | 24 | 955-965 | ||
| S42436K | 08 | 564-566 | S43022A | 24 | 955-965 | S4402XD | 23 | 949-950 | ||
| S42436P | 08 | 564-566 | S43022D | 23 | 949-950 | S4402XS | 01 | 091-093 | ||
| S42436S | 08 | 559-561 | S43022S | 08 | 562-563 | S4410XA | 01 | 073-074 | ||
| S42441A | 08 | 562-563 | S43023A | 08 | 562-563 | S4410XA | 24 | 955-965 | ||
| S42441A | 24 | 955-965 | S43023A | 24 | 955-965 | S4410XD | 23 | 949-950 | ||
| S42441B | 08 | 562-563 | S43023D | 23 | 949-950 | S4410XS | 01 | 091-093 | ||
| S42441B | 24 | 955-965 | S43023S | 08 | 562-563 | S4411XA | 01 | 073-074 | ||
| S42441D | 08 | 559-561 | S43024A | 08 | 562-563 | S4411XA | 24 | 955-965 | ||
| S42441G | 08 | 559-561 | S43024A | 24 | 955-965 | S4411XD | 23 | 949-950 | ||
| S42441K | 08 | 564-566 | S43024D | 23 | 949-950 | S4411XS | 01 | 091-093 | ||
| S42441P | 08 | 564-566 | S43024S | 08 | 562-563 | S4412XA | 01 | 073-074 | ||
| S42441S | 08 | 559-561 | S43025A | 08 | 562-563 | S4412XA | 24 | 955-965 | ||
| S42442A | 08 | 562-563 | S43025A | 24 | 955-965 | S4412XD | 23 | 949-950 | ||
| S42442A | 24 | 955-965 | S43025D | 23 | 949-950 | S4412XS | 01 | 091-093 | ||
| S42442B | 08 | 562-563 | S43025S | 08 | 562-563 | S4420XA | 01 | 073-074 | ||
| S42442B | 24 | 955-965 | S43026A | 08 | 562-563 | S4420XA | 24 | 955-965 | ||
| S42442D | 08 | 559-561 | S43026A | 24 | 955-965 | S4420XD | 23 | 949-950 | ||
| S42442G | 08 | 559-561 | S43026D | 23 | 949-950 | S4420XS | 01 | 091-093 | ||
| S42442K | 08 | 564-566 | S43026S | 08 | 562-563 | S4421XA | 01 | 073-074 | ||
| S42442P | 08 | 564-566 | S43031A | 08 | 562-563 | S4421XA | 24 | 955-965 | ||
| S42442S | 08 | 559-561 | S43031A | 24 | 955-965 | S4421XD | 23 | 949-950 | ||
| S42443A | 08 | 562-563 | S43031D | 23 | 949-950 | S4421XS | 01 | 091-093 | ||
| S42443A | 24 | 955-965 | S43031S | 08 | 562-563 | S4422XA | 01 | 073-074 | ||
| S42443B | 08 | 562-563 | S43032A | 08 | 562-563 | S4422XA | 24 | 955-965 | ||
| S42443B | 24 | 955-965 | S43032A | 24 | 955-965 | S4422XD | 23 | 949-950 | ||
| S42443D | 08 | 559-561 | S43032D | 23 | 949-950 | S4422XS | 01 | 091-093 | ||
| S42443G | 08 | 559-561 | S43032S | 08 | 562-563 | S4430XA | 01 | 073-074 | ||
| S42443K | 08 | 564-566 | S43033A | 08 | 562-563 | S4430XA | 24 | 955-965 | ||
| S42443P | 08 | 564-566 | S43033A | 24 | 955-965 | S4430XD | 23 | 949-950 | ||
| S42443S | 08 | 559-561 | S43033D | 23 | 949-950 | S4430XS | 01 | 091-093 | ||
| S42444A | 08 | 562-563 | S43033S | 08 | 562-563 | S4431XA | 01 | 073-074 | ||
| S42444A | 24 | 955-965 | S43034A | 08 | 562-563 | S4431XA | 24 | 955-965 | ||
| S42444B | 08 | 562-563 | S43034A | 24 | 955-965 | S4431XD | 23 | 949-950 | ||
| S42444B | 24 | 955-965 | S43034D | 23 | 949-950 | S4431XS | 01 | 091-093 | ||
| S42444D | 08 | 559-561 | S43034S | 08 | 562-563 | S4432XA | 01 | 073-074 | ||
| S42444G | 08 | 559-561 | S43035A | 08 | 562-563 | S4432XA | 24 | 955-965 | ||
| S42444K | 08 | 564-566 | S43035A | 24 | 955-965 | S4432XD | 23 | 949-950 | ||
| S42444P | 08 | 564-566 | S43035D | 23 | 949-950 | S4432XS | 01 | 091-093 | ||
| S42444S | 08 | 559-561 | S43035S | 08 | 562-563 | S4440XA | 01 | 073-074 | ||
| S42445A | 08 | 562-563 | S43036A | 08 | 562-563 | S4440XA | 24 | 955-965 | ||
| S42445A | 24 | 955-965 | S43036A | 24 | 955-965 | S4440XD | 23 | 949-950 | ||
| S42445B | 08 | 562-563 | S43036D | 23 | 949-950 | S4440XS | 01 | 091-093 | ||
| S42445B | 24 | 955-965 | S43036S | 08 | 562-563 | S4441XA | 01 | 073-074 | ||
| S42445D | 08 | 559-561 | S43081A | 08 | 562-563 | S4441XA | 24 | 955-965 | ||
| S42445G | 08 | 559-561 | S43081A | 24 | 955-965 | S4441XD | 23 | 949-950 | ||
| S42445K | 08 | 564-566 | S43081D | 23 | 949-950 | S4441XS | 01 | 091-093 | ||
| S42445P | 08 | 564-566 | S43081S | 08 | 562-563 | S4442XA | 01 | 073-074 | ||
| S42445S | 08 | 559-561 | S43082A | 08 | 562-563 | S4442XA | 24 | 955-965 | ||
| S42446A | 08 | 562-563 | S43082A | 24 | 955-965 | S4442XD | 23 | 949-950 | ||
| S42446A | 24 | 955-965 | S43082D | 23 | 949-950 | S4442XS | 01 | 091-093 | ||
| S42446B | 08 | 562-563 | S43082S | 08 | 562-563 | S4450XA | 01 | 073-074 | ||
| S42446B | 24 | 955-965 | S43083A | 08 | 562-563 | S4450XA | 24 | 955-965 | ||
| S42446D | 08 | 559-561 | S43083A | 24 | 955-965 | S4450XD | 23 | 949-950 | ||
| S42446G | 08 | 559-561 | S43083D | 23 | 949-950 | S4450XS | 01 | 091-093 | ||
| S42446K | 08 | 564-566 | S43083S | 08 | 562-563 | S4451XA | 01 | 073-074 | ||
| S42446P | 08 | 564-566 | S43084A | 08 | 562-563 | S4451XA | 24 | 955-965 | ||
| S42446S | 08 | 559-561 | S43084A | 24 | 955-965 | S4451XD | 23 | 949-950 | ||
| S42447A | 08 | 562-563 | S43084D | 23 | 949-950 | S4451XS | 01 | 091-093 | ||
| S42447A | 24 | 955-965 | S43084S | 08 | 562-563 | S4452XA | 01 | 073-074 | ||
| S42447B | 08 | 562-563 | S43085A | 08 | 562-563 | S4452XA | 24 | 955-965 | ||
| S42447B | 24 | 955-965 | S43085A | 24 | 955-965 | S4452XD | 23 | 949-950 | ||
| S42447D | 08 | 559-561 | S43085D | 23 | 949-950 | S4452XS | 01 | 091-093 | ||
| S42447G | 08 | 559-561 | S43085S | 08 | 562-563 | S448X1A | 01 | 073-074 | ||
| S42447K | 08 | 564-566 | S43086A | 08 | 562-563 | S448X1A | 24 | 955-965 | ||
| S42447P | 08 | 564-566 | S43086A | 24 | 955-965 | S448X1D | 23 | 949-950 | ||
| S42447S | 08 | 559-561 | S43086D | 23 | 949-950 | S448X1S | 01 | 091-093 | ||
| S42448A | 08 | 562-563 | S43086S | 08 | 562-563 | S448X2A | 01 | 073-074 | ||
| S42448A | 24 | 955-965 | S43101A | 08 | 562-563 | S448X2A | 24 | 955-965 | ||
| S42448B | 08 | 562-563 | S43101A | 24 | 955-965 | S448X2D | 23 | 949-950 | ||
| S42448B | 24 | 955-965 | S43101D | 23 | 949-950 | S448X2S | 01 | 091-093 | ||
| S42448D | 08 | 559-561 | S43101S | 08 | 562-563 | S448X9A | 01 | 073-074 | ||
| S42448G | 08 | 559-561 | S43102A | 08 | 562-563 | S448X9A | 24 | 955-965 | ||
| S42448K | 08 | 564-566 | S43102A | 24 | 955-965 | S448X9D | 23 | 949-950 | ||
| S42448P | 08 | 564-566 | S43102D | 23 | 949-950 | S448X9S | 01 | 091-093 | ||
| S42448S | 08 | 559-561 | S43102S | 08 | 562-563 | S4490XA | 01 | 073-074 | ||
| S42449A | 08 | 562-563 | S43109A | 08 | 562-563 | S4490XA | 24 | 955-965 | ||
| S42449A | 24 | 955-965 | S43109A | 24 | 955-965 | S4490XD | 23 | 949-950 | ||
| S42449B | 08 | 562-563 | S43109D | 23 | 949-950 | S4490XS | 01 | 091-093 | ||
| S42449B | 24 | 955-965 | S43109S | 08 | 562-563 | S4491XA | 01 | 073-074 | ||
| S42449D | 08 | 559-561 | S43111A | 08 | 562-563 | S4491XA | 24 | 955-965 | ||
| S42449G | 08 | 559-561 | S43111A | 24 | 955-965 | S4491XD | 23 | 949-950 | ||
| S42449K | 08 | 564-566 | S43111D | 23 | 949-950 | S4491XS | 01 | 091-093 | ||
| S42449P | 08 | 564-566 | S43111S | 08 | 562-563 | S4492XA | 01 | 073-074 | ||
| S42449S | 08 | 559-561 | S43112A | 08 | 562-563 | S4492XA | 24 | 955-965 | ||
| S42451A | 08 | 562-563 | S43112A | 24 | 955-965 | S4492XD | 23 | 949-950 | ||
| S42451A | 24 | 955-965 | S43112D | 23 | 949-950 | S4492XS | 01 | 091-093 | ||
| S42451B | 08 | 562-563 | S43112S | 08 | 562-563 | S45001A | 21 | 913-914 | ||
| S42451B | 24 | 955-965 | S43119A | 08 | 562-563 | S45001A | 24 | 955-965 | ||
| S42451D | 08 | 559-561 | S43119A | 24 | 955-965 | S45001D | 23 | 949-950 | ||
| S42451G | 08 | 559-561 | S43119D | 23 | 949-950 | S45001S | 05 | 299-301 | ||
| S42451K | 08 | 564-566 | S43119S | 08 | 562-563 | S45002A | 21 | 913-914 | ||
| S42451P | 08 | 564-566 | S43121A | 08 | 562-563 | S45002A | 24 | 955-965 | ||
| S42451S | 08 | 559-561 | S43121A | 24 | 955-965 | S45002D | 23 | 949-950 | ||
| S42452A | 08 | 562-563 | S43121D | 23 | 949-950 | S45002S | 05 | 299-301 | ||
| S42452A | 24 | 955-965 | S43121S | 08 | 562-563 | S45009A | 21 | 913-914 | ||
| S42452B | 08 | 562-563 | S43122A | 08 | 562-563 | S45009A | 24 | 955-965 | ||
| S42452B | 24 | 955-965 | S43122A | 24 | 955-965 | S45009D | 23 | 949-950 | ||
| S42452D | 08 | 559-561 | S43122D | 23 | 949-950 | S45009S | 05 | 299-301 | ||
| S42452G | 08 | 559-561 | S43122S | 08 | 562-563 | S45011A | 21 | 913-914 | ||
| S42452K | 08 | 564-566 | S43129A | 08 | 562-563 | S45011A | 24 | 955-965 | ||
| S42452P | 08 | 564-566 | S43129A | 24 | 955-965 | S45011D | 23 | 949-950 | ||
| S42452S | 08 | 559-561 | S43129D | 23 | 949-950 | S45011S | 05 | 299-301 | ||
| S42453A | 08 | 562-563 | S43129S | 08 | 562-563 | S45012A | 21 | 913-914 | ||
| S42453A | 24 | 955-965 | S43131A | 08 | 562-563 | S45012A | 24 | 955-965 | ||
| S42453B | 08 | 562-563 | S43131A | 24 | 955-965 | S45012D | 23 | 949-950 | ||
| S42453B | 24 | 955-965 | S43131D | 23 | 949-950 | S45012S | 05 | 299-301 | ||
| S42453D | 08 | 559-561 | S43131S | 08 | 562-563 | S45019A | 21 | 913-914 | ||
| S42453G | 08 | 559-561 | S43132A | 08 | 562-563 | S45019A | 24 | 955-965 | ||
| S42453K | 08 | 564-566 | S43132A | 24 | 955-965 | S45019D | 23 | 949-950 | ||
| S42453P | 08 | 564-566 | S43132D | 23 | 949-950 | S45019S | 05 | 299-301 | ||
| S42453S | 08 | 559-561 | S43132S | 08 | 562-563 | S45091A | 21 | 913-914 | ||
| S42454A | 08 | 562-563 | S43139A | 08 | 562-563 | S45091A | 24 | 955-965 | ||
| S42454A | 24 | 955-965 | S43139A | 24 | 955-965 | S45091D | 23 | 949-950 | ||
| S42454B | 08 | 562-563 | S43139D | 23 | 949-950 | S45091S | 05 | 299-301 | ||
| S42454B | 24 | 955-965 | S43139S | 08 | 562-563 | S45092A | 21 | 913-914 | ||
| S42454D | 08 | 559-561 | S43141A | 08 | 562-563 | S45092A | 24 | 955-965 | ||
| S42454G | 08 | 559-561 | S43141A | 24 | 955-965 | S45092D | 23 | 949-950 | ||
| S42454K | 08 | 564-566 | S43141D | 23 | 949-950 | S45092S | 05 | 299-301 | ||
| S42454P | 08 | 564-566 | S43141S | 08 | 562-563 | S45099A | 21 | 913-914 | ||
| S42454S | 08 | 559-561 | S43142A | 08 | 562-563 | S45099A | 24 | 955-965 | ||
| S42455A | 08 | 562-563 | S43142A | 24 | 955-965 | S45099D | 23 | 949-950 | ||
| S42455A | 24 | 955-965 | S43142D | 23 | 949-950 | S45099S | 05 | 299-301 | ||
| S42455B | 08 | 562-563 | S43142S | 08 | 562-563 | S45101A | 21 | 913-914 | ||
| S42455B | 24 | 955-965 | S43149A | 08 | 562-563 | S45101A | 24 | 955-965 | ||
| S42455D | 08 | 559-561 | S43149A | 24 | 955-965 | S45101D | 23 | 949-950 | ||
| S42455G | 08 | 559-561 | S43149D | 23 | 949-950 | S45101S | 05 | 299-301 | ||
| S42455K | 08 | 564-566 | S43149S | 08 | 562-563 | S45102A | 21 | 913-914 | ||
| S42455P | 08 | 564-566 | S43151A | 08 | 562-563 | S45102A | 24 | 955-965 | ||
| S42455S | 08 | 559-561 | S43151A | 24 | 955-965 | S45102D | 23 | 949-950 | ||
| S42456A | 08 | 562-563 | S43151D | 23 | 949-950 | S45102S | 05 | 299-301 | ||
| S42456A | 24 | 955-965 | S43151S | 08 | 562-563 | S45109A | 21 | 913-914 | ||
| S42456B | 08 | 562-563 | S43152A | 08 | 562-563 | S45109A | 24 | 955-965 | ||
| S42456B | 24 | 955-965 | S43152A | 24 | 955-965 | S45109D | 23 | 949-950 | ||
| S42456D | 08 | 559-561 | S43152D | 23 | 949-950 | S45109S | 05 | 299-301 | ||
| S42456G | 08 | 559-561 | S43152S | 08 | 562-563 | S45111A | 21 | 913-914 | ||
| S42456K | 08 | 564-566 | S43159A | 08 | 562-563 | S45111A | 24 | 955-965 | ||
| S42456P | 08 | 564-566 | S43159A | 24 | 955-965 | S45111D | 23 | 949-950 | ||
| S42456S | 08 | 559-561 | S43159D | 23 | 949-950 | S45111S | 05 | 299-301 | ||
| S42461A | 08 | 562-563 | S43159S | 08 | 562-563 | S45112A | 21 | 913-914 | ||
| S42461A | 24 | 955-965 | S43201A | 04 | 183-185 | S45112A | 24 | 955-965 | ||
| S42461B | 08 | 562-563 | S43201A | 24 | 955-965 | S45112D | 23 | 949-950 | ||
| S42461B | 24 | 955-965 | S43201D | 23 | 949-950 | S45112S | 05 | 299-301 | ||
| S42461D | 08 | 559-561 | S43201S | 08 | 562-563 | S45119A | 21 | 913-914 | ||
| S42461G | 08 | 559-561 | S43202A | 04 | 183-185 | S45119A | 24 | 955-965 | ||
| S42461K | 08 | 564-566 | S43202A | 24 | 955-965 | S45119D | 23 | 949-950 | ||
| S42461P | 08 | 564-566 | S43202D | 23 | 949-950 | S45119S | 05 | 299-301 | ||
| S42461S | 08 | 559-561 | S43202S | 08 | 562-563 | S45191A | 21 | 913-914 | ||
| S42462A | 08 | 562-563 | S43203A | 04 | 183-185 | S45191A | 24 | 955-965 | ||
| S42462A | 24 | 955-965 | S43203A | 24 | 955-965 | S45191D | 23 | 949-950 | ||
| S42462B | 08 | 562-563 | S43203D | 23 | 949-950 | S45191S | 05 | 299-301 | ||
| S42462B | 24 | 955-965 | S43203S | 08 | 562-563 | S45192A | 21 | 913-914 | ||
| S42462D | 08 | 559-561 | S43204A | 04 | 183-185 | S45192A | 24 | 955-965 | ||
| S42462G | 08 | 559-561 | S43204A | 24 | 955-965 | S45192D | 23 | 949-950 | ||
| S42462K | 08 | 564-566 | S43204D | 23 | 949-950 | S45192S | 05 | 299-301 | ||
| S42462P | 08 | 564-566 | S43204S | 08 | 562-563 | S45199A | 21 | 913-914 | ||
| S42462S | 08 | 559-561 | S43205A | 04 | 183-185 | S45199A | 24 | 955-965 | ||
| S42463A | 08 | 562-563 | S43205A | 24 | 955-965 | S45199D | 23 | 949-950 | ||
| S42463A | 24 | 955-965 | S43205D | 23 | 949-950 | S45199S | 05 | 299-301 | ||
| S42463B | 08 | 562-563 | S43205S | 08 | 562-563 | S45201A | 21 | 913-914 | ||
| S42463B | 24 | 955-965 | S43206A | 04 | 183-185 | S45201A | 24 | 955-965 | ||
| S42463D | 08 | 559-561 | S43206A | 24 | 955-965 | S45201D | 23 | 949-950 | ||
| S42463G | 08 | 559-561 | S43206D | 23 | 949-950 | S45201S | 05 | 299-301 | ||
| S42463K | 08 | 564-566 | S43206S | 08 | 562-563 | S45202A | 21 | 913-914 | ||
| S42463P | 08 | 564-566 | S43211A | 04 | 183-185 | S45202A | 24 | 955-965 | ||
| S42463S | 08 | 559-561 | S43211A | 24 | 955-965 | S45202D | 23 | 949-950 | ||
| S42464A | 08 | 562-563 | S43211D | 23 | 949-950 | S45202S | 05 | 299-301 | ||
| S42464A | 24 | 955-965 | S43211S | 08 | 562-563 | S45209A | 21 | 913-914 | ||
| S42464B | 08 | 562-563 | S43212A | 04 | 183-185 | S45209A | 24 | 955-965 | ||
| S42464B | 24 | 955-965 | S43212A | 24 | 955-965 | S45209D | 23 | 949-950 | ||
| S42464D | 08 | 559-561 | S43212D | 23 | 949-950 | S45209S | 05 | 299-301 | ||
| S42464G | 08 | 559-561 | S43212S | 08 | 562-563 | S45211A | 21 | 913-914 | ||
| S42464K | 08 | 564-566 | S43213A | 04 | 183-185 | S45211A | 24 | 955-965 | ||
| S42464P | 08 | 564-566 | S43213A | 24 | 955-965 | S45211D | 23 | 949-950 | ||
| S42464S | 08 | 559-561 | S43213D | 23 | 949-950 | S45211S | 05 | 299-301 | ||
| S42465A | 08 | 562-563 | S43213S | 08 | 562-563 | S45212A | 21 | 913-914 | ||
| S42465A | 24 | 955-965 | S43214A | 04 | 183-185 | S45212A | 24 | 955-965 | ||
| S42465B | 08 | 562-563 | S43214A | 24 | 955-965 | S45212D | 23 | 949-950 | ||
| S42465B | 24 | 955-965 | S43214D | 23 | 949-950 | S45212S | 05 | 299-301 | ||
| S42465D | 08 | 559-561 | S43214S | 08 | 562-563 | S45219A | 21 | 913-914 | ||
| S42465G | 08 | 559-561 | S43215A | 04 | 183-185 | S45219A | 24 | 955-965 | ||
| S42465K | 08 | 564-566 | S43215A | 24 | 955-965 | S45219D | 23 | 949-950 | ||
| S42465P | 08 | 564-566 | S43215D | 23 | 949-950 | S45219S | 05 | 299-301 | ||
| S42465S | 08 | 559-561 | S43215S | 08 | 562-563 | S45291A | 21 | 913-914 | ||
| S42466A | 08 | 562-563 | S43216A | 04 | 183-185 | S45291A | 24 | 955-965 | ||
| S42466A | 24 | 955-965 | S43216A | 24 | 955-965 | S45291D | 23 | 949-950 | ||
| S42466B | 08 | 562-563 | S43216D | 23 | 949-950 | S45291S | 05 | 299-301 | ||
| S42466B | 24 | 955-965 | S43216S | 08 | 562-563 | S45292A | 21 | 913-914 | ||
| S42466D | 08 | 559-561 | S43221A | 04 | 183-185 | S45292A | 24 | 955-965 | ||
| S42466G | 08 | 559-561 | S43221A | 24 | 955-965 | S45292D | 23 | 949-950 | ||
| S42466K | 08 | 564-566 | S43221D | 23 | 949-950 | S45292S | 05 | 299-301 | ||
| S42466P | 08 | 564-566 | S43221S | 08 | 562-563 | S45299A | 21 | 913-914 | ||
| S42466S | 08 | 559-561 | S43222A | 04 | 183-185 | S45299A | 24 | 955-965 | ||
| S42471A | 08 | 562-563 | S43222A | 24 | 955-965 | S45299D | 23 | 949-950 | ||
| S42471A | 24 | 955-965 | S43222D | 23 | 949-950 | S45299S | 05 | 299-301 | ||
| S42471B | 08 | 562-563 | S43222S | 08 | 562-563 | S45301A | 21 | 913-914 | ||
| S42471B | 24 | 955-965 | S43223A | 04 | 183-185 | S45301A | 24 | 955-965 | ||
| S42471D | 08 | 559-561 | S43223A | 24 | 955-965 | S45301D | 23 | 949-950 | ||
| S42471G | 08 | 559-561 | S43223D | 23 | 949-950 | S45301S | 05 | 299-301 | ||
| S42471K | 08 | 564-566 | S43223S | 08 | 562-563 | S45302A | 21 | 913-914 | ||
| S42471P | 08 | 564-566 | S43224A | 04 | 183-185 | S45302A | 24 | 955-965 | ||
| S42471S | 08 | 559-561 | S43224A | 24 | 955-965 | S45302D | 23 | 949-950 | ||
| S42472A | 08 | 562-563 | S43224D | 23 | 949-950 | S45302S | 05 | 299-301 | ||
| S42472A | 24 | 955-965 | S43224S | 08 | 562-563 | S45309A | 21 | 913-914 | ||
| S42472B | 08 | 562-563 | S43225A | 04 | 183-185 | S45309A | 24 | 955-965 | ||
| S42472B | 24 | 955-965 | S43225A | 24 | 955-965 | S45309D | 23 | 949-950 | ||
| S42472D | 08 | 559-561 | S43225D | 23 | 949-950 | S45309S | 05 | 299-301 | ||
| S42472G | 08 | 559-561 | S43225S | 08 | 562-563 | S45311A | 21 | 913-914 | ||
| S42472K | 08 | 564-566 | S43226A | 04 | 183-185 | S45311A | 24 | 955-965 | ||
| S42472P | 08 | 564-566 | S43226A | 24 | 955-965 | S45311D | 23 | 949-950 | ||
| S42472S | 08 | 559-561 | S43226D | 23 | 949-950 | S45311S | 05 | 299-301 | ||
| S42473A | 08 | 562-563 | S43226S | 08 | 562-563 | S45312A | 21 | 913-914 | ||
| S42473A | 24 | 955-965 | S43301A | 08 | 562-563 | S45312A | 24 | 955-965 | ||
| S42473B | 08 | 562-563 | S43301A | 24 | 955-965 | S45312D | 23 | 949-950 | ||
| S42473B | 24 | 955-965 | S43301D | 23 | 949-950 | S45312S | 05 | 299-301 | ||
| S42473D | 08 | 559-561 | S43301S | 08 | 562-563 | S45319A | 21 | 913-914 | ||
| S42473G | 08 | 559-561 | S43302A | 08 | 562-563 | S45319A | 24 | 955-965 | ||
| S42473K | 08 | 564-566 | S43302A | 24 | 955-965 | S45319D | 23 | 949-950 | ||
| S42473P | 08 | 564-566 | S43302D | 23 | 949-950 | S45319S | 05 | 299-301 | ||
| S42473S | 08 | 559-561 | S43302S | 08 | 562-563 | S45391A | 21 | 913-914 | ||
| S42474A | 08 | 562-563 | S43303A | 08 | 562-563 | S45391A | 24 | 955-965 | ||
| S42474A | 24 | 955-965 | S43303A | 24 | 955-965 | S45391D | 23 | 949-950 | ||
| S42474B | 08 | 562-563 | S43303D | 23 | 949-950 | S45391S | 05 | 299-301 | ||
| S42474B | 24 | 955-965 | S43303S | 08 | 562-563 | S45392A | 21 | 913-914 | ||
| S42474D | 08 | 559-561 | S43304A | 08 | 562-563 | S45392A | 24 | 955-965 | ||
| S42474G | 08 | 559-561 | S43304A | 24 | 955-965 | S45392D | 23 | 949-950 | ||
| S42474K | 08 | 564-566 | S43304D | 23 | 949-950 | S45392S | 05 | 299-301 | ||
| S42474P | 08 | 564-566 | S43304S | 08 | 562-563 | S45399A | 21 | 913-914 | ||
| S42474S | 08 | 559-561 | S43305A | 08 | 562-563 | S45399A | 24 | 955-965 | ||
| S42475A | 08 | 562-563 | S43305A | 24 | 955-965 | S45399D | 23 | 949-950 | ||
| S42475A | 24 | 955-965 | S43305D | 23 | 949-950 | S45399S | 05 | 299-301 | ||
| S42475B | 08 | 562-563 | S43305S | 08 | 562-563 | S45801A | 21 | 913-914 | ||
| S42475B | 24 | 955-965 | S43306A | 08 | 562-563 | S45801A | 24 | 955-965 | ||
| S42475D | 08 | 559-561 | S43306A | 24 | 955-965 | S45801D | 23 | 949-950 | ||
| S42475G | 08 | 559-561 | S43306D | 23 | 949-950 | S45801S | 05 | 299-301 | ||
| S42475K | 08 | 564-566 | S43306S | 08 | 562-563 | S45802A | 21 | 913-914 | ||
| S42475P | 08 | 564-566 | S43311A | 08 | 562-563 | S45802A | 24 | 955-965 | ||
| S42475S | 08 | 559-561 | S43311A | 24 | 955-965 | S45802D | 23 | 949-950 | ||
| S42476A | 08 | 562-563 | S43311D | 23 | 949-950 | S45802S | 05 | 299-301 | ||
| S42476A | 24 | 955-965 | S43311S | 08 | 562-563 | S45809A | 21 | 913-914 | ||
| S42476B | 08 | 562-563 | S43312A | 08 | 562-563 | S45809A | 24 | 955-965 | ||
| S42476B | 24 | 955-965 | S43312A | 24 | 955-965 | S45809D | 23 | 949-950 | ||
| S42476D | 08 | 559-561 | S43312D | 23 | 949-950 | S45809S | 05 | 299-301 | ||
| S42476G | 08 | 559-561 | S43312S | 08 | 562-563 | S45811A | 21 | 913-914 | ||
| S42476K | 08 | 564-566 | S43313A | 08 | 562-563 | S45811A | 24 | 955-965 | ||
| S42476P | 08 | 564-566 | S43313A | 24 | 955-965 | S45811D | 23 | 949-950 | ||
| S42476S | 08 | 559-561 | S43313D | 23 | 949-950 | S45811S | 05 | 299-301 | ||
| S42481A | 08 | 562-563 | S43313S | 08 | 562-563 | S45812A | 21 | 913-914 | ||
| S42481A | 24 | 955-965 | S43314A | 08 | 562-563 | S45812A | 24 | 955-965 | ||
| S42481D | 08 | 559-561 | S43314A | 24 | 955-965 | S45812D | 23 | 949-950 | ||
| S42481G | 08 | 559-561 | S43314D | 23 | 949-950 | S45812S | 05 | 299-301 | ||
| S42481K | 08 | 564-566 | S43314S | 08 | 562-563 | S45819A | 21 | 913-914 | ||
| S42481P | 08 | 564-566 | S43315A | 08 | 562-563 | S45819A | 24 | 955-965 | ||
| S42481S | 08 | 559-561 | S43315A | 24 | 955-965 | S45819D | 23 | 949-950 | ||
| S42482A | 08 | 562-563 | S43315D | 23 | 949-950 | S45819S | 05 | 299-301 | ||
| S42482A | 24 | 955-965 | S43315S | 08 | 562-563 | S45891A | 21 | 913-914 | ||
| S42482D | 08 | 559-561 | S43316A | 08 | 562-563 | S45891A | 24 | 955-965 | ||
| S42482G | 08 | 559-561 | S43316A | 24 | 955-965 | S45891D | 23 | 949-950 | ||
| S42482K | 08 | 564-566 | S43316D | 23 | 949-950 | S45891S | 05 | 299-301 | ||
| S42482P | 08 | 564-566 | S43316S | 08 | 562-563 | S45892A | 21 | 913-914 | ||
| S42482S | 08 | 559-561 | S43391A | 08 | 562-563 | S45892A | 24 | 955-965 | ||
| S42489A | 08 | 562-563 | S43391A | 24 | 955-965 | S45892D | 23 | 949-950 | ||
| S42489A | 24 | 955-965 | S43391D | 23 | 949-950 | S45892S | 05 | 299-301 | ||
| S42489D | 08 | 559-561 | S43391S | 08 | 562-563 | S45899A | 21 | 913-914 | ||
| S42489G | 08 | 559-561 | S43392A | 08 | 562-563 | S45899A | 24 | 955-965 | ||
| S42489K | 08 | 564-566 | S43392A | 24 | 955-965 | S45899D | 23 | 949-950 | ||
| S42489P | 08 | 564-566 | S43392D | 23 | 949-950 | S45899S | 05 | 299-301 | ||
| S42489S | 08 | 559-561 | S43392S | 08 | 562-563 | S45901A | 21 | 913-914 | ||
| S42491A | 08 | 562-563 | S43393A | 08 | 562-563 | S45901A | 24 | 955-965 | ||
| S42491A | 24 | 955-965 | S43393A | 24 | 955-965 | S45901D | 23 | 949-950 | ||
| S42491B | 08 | 562-563 | S43393D | 23 | 949-950 | S45901S | 05 | 299-301 | ||
| S42491B | 24 | 955-965 | S43393S | 08 | 562-563 | S45902A | 21 | 913-914 | ||
| S42491D | 08 | 559-561 | S43394A | 08 | 562-563 | S45902A | 24 | 955-965 | ||
| S42491G | 08 | 559-561 | S43394A | 24 | 955-965 | S45902D | 23 | 949-950 | ||
| S42491K | 08 | 564-566 | S43394D | 23 | 949-950 | S45902S | 05 | 299-301 | ||
| S42491P | 08 | 564-566 | S43394S | 08 | 562-563 | S45909A | 21 | 913-914 | ||
| S42491S | 08 | 559-561 | S43395A | 08 | 562-563 | S45909A | 24 | 955-965 | ||
| S42492A | 08 | 562-563 | S43395A | 24 | 955-965 | S45909D | 23 | 949-950 | ||
| S42492A | 24 | 955-965 | S43395D | 23 | 949-950 | S45909S | 05 | 299-301 | ||
| S42492B | 08 | 562-563 | S43395S | 08 | 562-563 | S45911A | 21 | 913-914 | ||
| S42492B | 24 | 955-965 | S43396A | 08 | 562-563 | S45911A | 24 | 955-965 | ||
| S42492D | 08 | 559-561 | S43396A | 24 | 955-965 | S45911D | 23 | 949-950 | ||
| S42492G | 08 | 559-561 | S43396D | 23 | 949-950 | S45911S | 05 | 299-301 | ||
| S42492K | 08 | 564-566 | S43396S | 08 | 562-563 | S45912A | 21 | 913-914 | ||
| S42492P | 08 | 564-566 | S43401A | 08 | 562-563 | S45912A | 24 | 955-965 | ||
| S42492S | 08 | 559-561 | S43401A | 24 | 955-965 | S45912D | 23 | 949-950 | ||
| S42493A | 08 | 562-563 | S43401D | 23 | 949-950 | S45912S | 05 | 299-301 | ||
| S42493A | 24 | 955-965 | S43401S | 08 | 562-563 | S45919A | 21 | 913-914 | ||
| S42493B | 08 | 562-563 | S43402A | 08 | 562-563 | S45919A | 24 | 955-965 | ||
| S42493B | 24 | 955-965 | S43402A | 24 | 955-965 | S45919D | 23 | 949-950 | ||
| S42493D | 08 | 559-561 | S43402D | 23 | 949-950 | S45919S | 05 | 299-301 | ||
| S42493G | 08 | 559-561 | S43402S | 08 | 562-563 | S45991A | 21 | 913-914 | ||
| S42493K | 08 | 564-566 | S43409A | 08 | 562-563 | S45991A | 24 | 955-965 | ||
| S42493P | 08 | 564-566 | S43409A | 24 | 955-965 | S45991D | 23 | 949-950 | ||
| S42493S | 08 | 559-561 | S43409D | 23 | 949-950 | S45991S | 05 | 299-301 | ||
| S42494A | 08 | 562-563 | S43409S | 08 | 562-563 | S45992A | 21 | 913-914 | ||
| S42494A | 24 | 955-965 | S43411A | 08 | 562-563 | S45992A | 24 | 955-965 | ||
| S42494B | 08 | 562-563 | S43411A | 24 | 955-965 | S45992D | 23 | 949-950 | ||
| S42494B | 24 | 955-965 | S43411D | 23 | 949-950 | S45992S | 05 | 299-301 | ||
| S42494D | 08 | 559-561 | S43411S | 08 | 562-563 | S45999A | 21 | 913-914 | ||
| S42494G | 08 | 559-561 | S43412A | 08 | 562-563 | S45999A | 24 | 955-965 | ||
| S42494K | 08 | 564-566 | S43412A | 24 | 955-965 | S45999D | 23 | 949-950 | ||
| S42494P | 08 | 564-566 | S43412D | 23 | 949-950 | S45999S | 05 | 299-301 | ||
| S42494S | 08 | 559-561 | S43412S | 08 | 562-563 | S46001A | 21 | 913-914 | ||
| S42495A | 08 | 562-563 | S43419A | 08 | 562-563 | S46001A | 24 | 955-965 | ||
| S42495A | 24 | 955-965 | S43419A | 24 | 955-965 | S46001D | 23 | 949-950 | ||
| S42495B | 08 | 562-563 | S43419D | 23 | 949-950 | S46001S | 21 | 913-914 | ||
| S42495B | 24 | 955-965 | S43419S | 08 | 562-563 | S46002A | 21 | 913-914 | ||
| S42495D | 08 | 559-561 | S43421A | 08 | 562-563 | S46002A | 24 | 955-965 | ||
| S42495G | 08 | 559-561 | S43421A | 24 | 955-965 | S46002D | 23 | 949-950 | ||
| S42495K | 08 | 564-566 | S43421D | 23 | 949-950 | S46002S | 21 | 913-914 | ||
| S42495P | 08 | 564-566 | S43421S | 08 | 562-563 | S46009A | 21 | 913-914 | ||
| S42495S | 08 | 559-561 | S43422A | 08 | 562-563 | S46009A | 24 | 955-965 | ||
| S42496A | 08 | 562-563 | S43422A | 24 | 955-965 | S46009D | 23 | 949-950 | ||
| S42496A | 24 | 955-965 | S43422D | 23 | 949-950 | S46009S | 21 | 913-914 | ||
| S42496B | 08 | 562-563 | S43422S | 08 | 562-563 | S46011A | 08 | 562-563 | ||
| S42496B | 24 | 955-965 | S43429A | 08 | 562-563 | S46011A | 24 | 955-965 | ||
| S42496D | 08 | 559-561 | S43429A | 24 | 955-965 | S46011D | 23 | 949-950 | ||
| S42496G | 08 | 559-561 | S43429D | 23 | 949-950 | S46011S | 08 | 562-563 | ||
| S42496K | 08 | 564-566 | S43429S | 08 | 562-563 | S46012A | 08 | 562-563 | ||
| S42496P | 08 | 564-566 | S43431A | 08 | 562-563 | S46012A | 24 | 955-965 | ||
| S42496S | 08 | 559-561 | S43431A | 24 | 955-965 | S46012D | 23 | 949-950 | ||
| S4290XA | 08 | 562-563 | S43431D | 23 | 949-950 | S46012S | 08 | 562-563 | ||
| S4290XA | 24 | 955-965 | S43431S | 08 | 562-563 | S46019A | 08 | 562-563 | ||
| S4290XB | 08 | 562-563 | S43432A | 08 | 562-563 | S46019A | 24 | 955-965 | ||
| S4290XB | 24 | 955-965 | S43432A | 24 | 955-965 | S46019D | 23 | 949-950 |
|
Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244 14 Apr 2020 14:43:32 CMS, code-revision=250, description-revision=1275 |